Prone and postural respiration in drowning and other forms of apnoea or suspended respiration

PRONE AND POSTURAL RESPIRATION

D R 0 ¥ N I N Cx

ETC.

Uinca spes est, unicum remedium.

scevamque exhalat MepJdtim .

ViRG. ^N. lib. vii, 1. 84.

J 1

^

&^

PHONE AND POSTURAL RESPIRATION

DROWNING

OTHER FORMS OF APNCEA OR SUSPENDED RESPIRATION ;

MAESHALL HALL, M.D. P.R.S.

OF THE INSTITUTE OF FRAXCE ;

FOREIGN ASSOCIATE OF THE ACADEMY OF MEDICINE OF PARIS ;

ETC. ETC.

EDITED BY HIS SON,

MARSHALL HALL, Esq.

LONDON :
JOHN CHURCHILL, NEW BURLINGTON STREET.

MDCCCLVII.

vVA

THIS LITTLE VOLrME IS DEDICAl ED
TO

GEOEGE WEBSTER, Esq. M.D.

OF DULWICH,

IN TESTIMONY OF AX rXIXTERRUPTED FRIEXDSHIP
OF THIRTY YEARS ;

AXD TO

THOSE STUDENTS OF ST. GEOKGE's HOSPITAL*

\\"H0,

WITH SUCH ZEAL, ABILITY AND PERSEVERANCE, AVOUKED OUT
THE PROBLEM OF

POSTURAL RESPIRATION ;

By MARSHALL HALL, M.D. etc.

August, ISo^

* EDWARD LONG FOX, ESQ. (NOW M D. OXON ),
CHAULtS HUNTER, ESQ. AUD ROBERT L. BOWLfS, KSQ.

I HAVE made it a sacred duty to assist in editing this
my Father's latest work, during the protracted and severe
illness, which terminated on the eleventh of this month
in his death — in a loss irreparable to the whole scientific
world.

This final leap of an expiring flame is far from being
the least brilliant of my Father's gifts to his profession
and to humanity.

My task has been easy. I have had little to do,
except to gather together and arrange the papers which
have appeared in a pamphlet and in " The Lancet/' and
some M.SS.

I should wiUingly have adopted the title given to the
life-restoring process of pronation and rotation of the
patient dying of apnoea, by the Editor of that journal,
and so cordially adopted by the profession :

" Any thing more simple, philosophical, or beautiful,
could not have been devised. It is proposed to call
the plan the ready method of treating the drowned.
Infinitely preferable, in our opinion, would be the title of
the MARSHALL HALL METHOD. This designation is
due to the distinguished discoverer; and the method
would thus be benevolently associated with his name to
the end of time."

MARSHALL HALL.

Blacklands, Galne, Wiltshire.
August, 1857.

PREFACE.

I am unwilling entirely to discard the evidence given
by so many who have treated apnoea, of recovery after a
very long immersion. And I have endeavoured to
imagine an event possible which has been rejected because
it has appeared impossible.

What takes place when all respiration and all circu-
lation have apparently ceased ? For from such a state,
in new-born infants especially, the patient has recovered.

Is there a low state of chemical change still per-
sistent under the influence of apncea and cold, from
which even the adult may be restored under the genial
influence of a gentle stream of atmospheric air into the
pulmonary air-cells and on the general surface of the
body ?

The damp hay-stack smoulders until some occasion
occurs of its low combustion being roused into spark and
flame.

Xll PREFACE.

A.nd a cainllary circulation and its blood-changes
may continue, when the heart has already ceased to con-
tract, which may render such restoration to life not
impossible. A frog in which, from the exclusion of
oxygen, the cutaneous circulation has ceased, if observed
under the microscope, has been known to become spon-
taneously restored on exposure to the atmospheric air.

Much more might be said on this subject and on low
and spontaneous combustion. Meantime, let us persevere
with our prone and postural respiration with alternate
pressure, and wait and watch and hope ; an efficient
artificial respiration has never yet been so promptly or
rather instantly applied as it may now be by means of —
Pronation and Kotation.

An investigation is opened to us full of promise of
life, even in cases of extremely long duration and un-
availing protracted treatment. We must cease to be
sceptical. Still-born infants have been restored after
a considerable lapse of time.

XHl

PAUT THE FIKST

IS NEARLY A VERBATIM REPRINT OF THE ESSAY I'REsENTK
TO THE ROYAL HUMANE SOCIETY IN JANUARY 1856.

PAET THE SECOND

CONSISTS IN A SIMILAR REPRINT OF PAPERS PUBLISHED IN THE

LANCET SINCE THAT DATE, WITH OBSERVATIONS

NOT YET PUBLISHED.

CASES.

WITH NOTES ON OBSOLETE MODES OF PRACTICE.

PART THE THIRD

CONSISTS IN SEVERAL PHYSIOLOGICAL VIEWS BEARING UPON
RESPIRATION AND APNOEA.

PAET FIRST.

THE PNtEOMETEK*

OR MEASURER OF POSTURAL RESPIRATION.

Vide p. 61.

PAET FIEST.
POSTURAL RESPIRATION

IN

DEOWNING,

ETC.

§ 1. — Introduction.

In the following pages I propose to treat of Apnoea
(from a, priv. and izv^uy respiro), its rationale and treat-
ment, in so succinct and plain a manner as to be useful
to those most interested in the practical results of such
inquiries. I shall keep in view that it is to promote the
benevolent objects of the Eoyal Humane Society that my
efforts are made.

My first aim will be to give a clear view of the nature
of the effects of suspended respiration ; my second, to
state the best means of restoring the patient affected by
that suspension.

The nature of normal respiration is entirely different
from that of the apparently respiratory movements in
continued apncea. The former is, as will be more
distinctly explained hereafter, reflex; that is, it is
excited by the carbonic acid exhaled from the blood into

B

Z POSTUEAL RESPIRATION IN DROWNING

the air-cells of the lungs, through nerves which proceed
to the spinal centre, traverse it in some mysterious man-
ner, and proceed from that centre to the muscles of
respiration ; the latter are centric, and are caused by
the action of the carbonic acid retained in the blood,
acting on the spinal centre itself and through certain
nerves which proceed from it on the muscles moved,
which are also different from the former ones.

This distinction, which is of the utmost importance,
has been established by my own experiments.

During the circulation, the oxygen inhaled in respi-
ration unites with the carbon in the blood, forming car-
bonic acid. This carbonic acid is exhaled in respiration
in its turn, except in the cases in which the respiration
is suspended, as in drowning and other forms of apnoea.

In apnoea, the carbonic acid retained in the blood
first poisons the brain, producing anaesthesia, uncon-
sciousness, and immobility; and then the spinal centre,
producing the gaspings so characteristic of this condition,
and constituting the last external sign of life.

After this, there is still a slight lingering movement
of the heart, on which the feeble hopes of the restoration
of the patient repose ; but speedily true asphyxia (from
a, priv. and o-^t^w, pulso), or the cessation of all pulsa-
tion and circulation, occurs.

Such is the course of events when the suspension of
respiration is complete. It is usually rapid and of short
duration. Sometimes, however, the suspension of respira-
tion is not absolute ; the patient may rise to the surface

AND OTHEE- FORMS OF APNCEA. d

and breathe; or there may be a state of syncope,
or of slioch, produced by the circumstances of the accident
and inducing 2^feelle circulation ; and then the duration
of the apnoea, with the hope of restoration, is more
protracted, that hope being directly as the persistence of
the respiration, and inversely as the rapidity of the cir-
culation.

The further hope of respiration by the means we em-
ploy is again directly as we excite or imitate respiration,
the restoration of the circulation being promoted by sham-
pooing, the warm bath, &c. only as subsidiary and second-
ary to respiration.

We must never forget that the circulation is a self-
poisoning, the respiration a f/e-poisoning, process. These
are the two principles by which we must be guided in
our treatment of apncea. On these topics I proceed
to treat more at length in the subsequent sections. I
beg my reader to pardon a few repetitions.

§ II, — The Distinction betvjeen Respiration and the
Respiratory Movements in Asphyxia.

Every one is familiar with the effect of dashing cold
water on the face, or of descending slowly into the cold
bath. The cutaneous nerves of the face or general sur-
face are impressed with the cold, and excite, through a
reflex action performed through these nerves and the
spinal centre, acts of inspiration.

B %

4 POSTURAL RESPIEATION IN DROWNING

Every one has experienced the effect on the nostrils
of the carbonic acid evolved from the stomach after taking
draughts of soda water.

In ordinary circumstances, it is the carbonic acid
gas exhaled from the blood through the fine membranous
tissues of the pulmonary air-cells, which, by exciting the
fine fibrillse of the pneumogastric nerve spread over those
air-cells, proves the constant excitant, through those
nerves and the spinal centre, of the normal acts of res-
piration.

To be more explicit, I may add that, in respiration,
oxygen gas is inspired ; it is absorbed into the blood,
and circulated with it ; in its systemic course it unites
with carbon, and forms carbonic acid ; this circulates in
the venous blood in its turn, is exhaled from it, proves
the excitant of a fresh inspiration in the pulmonary air-
cells, and is finally expired into the atmospheric air.

These acts I have designated reflex or ^Mstaltic,
because they are performed along certain «z-going nerves,
through the spinal centre, and along certain out-^om^
nerves eventually distributed to the muscles of respira-
tion. This ^i^staltic action is the essential character of
\}^% physiological acts of respiration.

All is changed in the case in which the normal acts
of respiration are obstructed, as in apnoea.

When the respiration is entirely suspended, there is
no exhalation of carbonic acid, the excitant of respiration ;
there can therefore be no r/mstaltic respiration ; but the
carbonic acid which ought to be exhaled in the lungs is

AND OTHER FORMS OP APNCEA. 0

retained in the blood, poisons it, circulates with it through
the system and its various organs, and excites various
abnormal conditions and actions. The mode of action
is now not ^i^staltic, but centric in the spinal centre and
^cstaltic. The respiratory movements are no longer nor-
mal and rhytlunic acts of inspiration and exspiration, but
abnormal and irregular ^.rpiratory movements, with a
peculiar opening of the mouth, flexion of the body, and
frequently with the ejection of foam, followed by in,-
spiratory efforts. Such is the character of the respiratory
movements in apnoea. They are pathological^ not phy-
siological ; and they are, I repeat, centric or ecstaltic
from the spinal centre, not ^^^staltic, through it.

The blood is poisoned by the carbonic acid so re-
tained; the organs are poisoned in their turn by this
blood-poison. Our most strenuous efforts must be ex-
erted to eliminate and remove this poison from the blood
and from the system. All other efforts are subsidiary,
although auxiliary ; and, if they at all take the place of
this, injurious.

The onli/ mode of thus eliminating the carbonic-acid
blood-poison is, to excite, or imitate, Respiration — the
one idea which it is the object of these pages to enforce.

Adopting fully the beautiful device of the Royal Hu-
mane Society, I would carry out its meaning still further,
and say that so to Moid the latent spark into flame, is
our hope, our only hope ; — imica spes est, unicum reme-
dium.

D POSTURAL EESPIRATTON IN DROWNING

To revert to the specific topic of this section, I would
again say — and this knowledge is entirely the result of
my own labours — that whilst the normal respiratory
movements are refiex in their mode of excitement, the
movements in apnoea are centric. Of the former cha-
racter too is fhepantinf/, wliich may be designated hyper-
pnoea, observed in some experimeats to be detailed here-
after; and of the latter, the peculiar phenomenon of
gasping, which may be termed, from its equivocal cha-
racter, pseudo'piKBa,.

§ III. — Belation of Respiration to the Circulation.

There is the strictest relation between the rapidity of
the circulation and that of the respiration. The number
of the pulsations of the heart preserves, in all physiolo-
gical conditions, the same ratio to the number of respi-
ratory movements. If the circulation be augmented, the
respiration becomes more frequent ; if the circulation be
retarded, the respiration is proportionately slower.

This ratio between the number and force of the con-
tractions of the heart and the number of the acts of
respiration is physiological, the result of cause and effect
and essential to life and health, in its varied forms
and conditions.

As the blood circulates, it receives the vivifying effect
of oxygen, and forms carbonic acid. This carbonic acid

AND OTHEE FORMS OF APNCEA. 7

is exhaled through the fine membranous tissue of the air-
cells, and coming then in contact with the minute origins
of the pueumogastric nerve, the internal excitor respira-
tory nerve, excites the successive acts of respiration.

The formation and the evolution of this carbonic acid
is greater in proportion to the quickness of the circula-
tion ; the rapidity of the respiration is proportionate to
the quantity of this carbonic acid so formed and so
evolved.

The circulation is rendered more rapid by muscular
effort, and diminished by repose. It is more rapid during
walking, less so during quiescence and sleep ; it is re-
duced to its minimum, physiologically, during the con-
tinued sleep of hibernation. The rapidity of the respi-
ration is proportionate to that of the circulation in all
these conditions.

Tlie circulation without respiration would be a self-
or hlood- poisoning process ; respiration is ^^-poisoning.
By respiration the carbonic-acid poison formed during
the circulation is eliminated from the blood and evolved
from the system, lis final purpose requires that it should
be, what it is, proportionate to the circulation. The
carbonic acid, when evolved from the blood, no longer a
poison, excites the respiration, which conveys it from the
system- — a wonderful adaptation of the means to the end !

In the state of hibernation, or extreme quiescence,
the velocity of the circulation is reduced to its minimum ;
that of the respiration is proportionately reduced.

In the state of extreme activity, the velocity of the

8 POSTURAL EESPIEATION IN DROWNING

circulation is augmented to its maximum : wliilst that of
the respiration {^proportionately augmented.

In the intermediate conditions of animal life, inter-
mediate phenomena of circulation and of respiration are
observed.

These interesting phenomena are thus readily ex-
plained. The excitant of ordinary respiration is the
carbonic acid gas, evolved by the blood circulating in the
fine membranes of the air-cells, and diffused into the con-
tiguous atmospheric air. This evolution of carbonic acid
from the circulating blood is proportionate to the rapidity
of the circulation ; and since this carbonic acid gas is the
excitant of the respiration, the rapidity of the respiration
becomes proportionate to that of the circulation in its
turn.

It is demonstrated by chemical analysis that the
quantity of carbonic acid evolved is really augmented
with the augmented rapidity of the circulation. When
the rapidity of the circulation and the quantity of evolved
carbonic acid are greatly augmented, the respiration h^-
com^^ panting — a phenomenon observed when, without
augmented circulation and evolution of carbonic acid,
this latter gas is added in a certain proportion to the
atmospheric air respired.

But that carbonic acid which, being evolved, thus
performs a most important and vital function, becomes,
if retained in the blood, as in suspended respiration, a
deadly poison, as I shall proceed to show in the following
sections; and as the quantity of the carbonic acid is

AND OTHEE FORMS OF APNCEA. 9

augmented by every acceleration of the circulation,
the rapidity of that process of poisoning in apncea is
proportionately great.

§ lY. — The Rationale of the Effects of Suspended
Respiration,

The phenomena of life result from the play of arterial
blood on the nervous and muscular tissues.

' The blood is supplied by the ingestion of food, and
purified by the egestion of the fseces and urine. It is
arterialized by the inlialation of oxygen and the exhala-
tion of carbonic acid in respiration.

Respiration consists in these two processes ; both of
which are suspended when the respiratory movements are
suspended, as in drowning or strangulation.

These two processes are of very different immediate
value to life : the inhalation of oxygen may be long nearly
suspended without proving fatal ; the suspension of the
exhalation of carbonic acid, even if incomplete, destroys
life in a comparatively very short time. These facts are
demonstrated by the following experiments :

Experiment 1. I placed an animal in a limited
portion of nitrogen gas, which, from our imperfect mode
of procedure, must have become mingled with a small
portion of atmospheric air : it continued to breathe with
freedom, only beginning io pant as the exhaled carbonic
acid began to accumulate.

10 POSTUEAL RESPIRATION IN DROWNING

In ^perfectly pure nitrogen or hydrogen gas, the
animal dies more speedily even than when submerged
under water — the oxygen already in the blood being
probably exhaled. The spark of life becomes almost
instantly extinct, with phenomena which are quite pe-
culiar, assuming the form of violent convulsive move-
ments.

One of the most extraordinary results of my expe-
riments is this : a mouse will live in an atmosphere of
nitrogen and oxygen, in which there is so little oxygen,
that a lighted taper is immediately extinguished, flame
and spark, — and die in an atmosphere of carbonic acid
and oxygen, in which there is so much oxygen, that a
taper blown out, leaving a spark, is immediately re-
inflamed. It is not the want of oxygen, but the excess
of carbonic acid, which proves fatal.

Tlx;p. 2. We placed an animal in carbonic acid : it
began to gas]} almost immediately, and soon expired.

In the first experiment, the inhalation of oxygen was
nearly excluded; in the second, the exhalation of car-
bonic acid was intercepted.

During the physiological condition of the functions,
oxygen is continually inhaled, and carbonic acid exhaled.
The former unites with the carbon in the blood and forms
the latter. The carbonic acid, if retained, becomes a
deadly poison. The blood, during its circulation, if
respiration be suspended, proves self-poisoning, by the
carbonic acid so formed and retained. This process of
self-poisoning is rapid in proportion to the rapidity of

AND OTHER FORMS OF APNCEA. 11

the circulation ; a fact which explains many of the phe-
nomena of apncea, and of the effects of our supposed
remedies.

The process of self-poisoning of the blood from the
suspension of respiration is readily traceable in experi-
ment :

Exp, 3. We submerged an animal in water, and
carefully watched the phenomena : there were, during
the Jirsl period of submersion, voluntary efforts to escape ;
then, a second period of stillness, or anc^sthesia, ^vithout
attempts either to move voluntarily or efforts to respire,
the retained carbonic acid poisoning the Irain, and not
escaping into the air-cells ; then followed a third period,
of gasjnng, which I propose to designate pseudojpncea,
conjoining opening of the mouth and expiratory move-
ments, with the rejection of foam, resulting from the
impression made by the carbonic-acid-poisoned blood on
the spinal centre; at length the gaspings cease, the
animal seems to be dead, but a lingering cnculation, the
value of which is not yet determined by experiment, re-
mains, but quickly subsides into true asjohi/xia.

Exj). 4. Instead of submerging the animal under
water, we placed it in a limited portion of atmospheric
air (of about three times its own bulk), and observed
the following phenomena : the breathing was at the first
perfectly natural, unless it was excited by emotion;
during a second period it became panting or hyperpncea,
the exhaled carbonic acid, when re-respired, acting as an
undue excitant of the pneumogastric nerves of the pul-

13 POSTURAL EESPIRATION IX DRO\VXING

monary air-cells ; this second period passes very gradually
into the third, or that oi gasping or pseudopncea, as the
carbonic-acid poison formed in the blood excites the
spinal centre, a period and a condition further marked
by 02^671 mouth, starts, a tottering gait, and paralytic
weakness of the posterior extremities, all denoting affec-
tion of the spinal centre.

The third period very gradually passes into the fourth,
or true asphyxia and death.

These phenomena proceed with a rapidity which is
inversely proportionate to the age of the animal, to its
temperature, to its degree of activity, and to its elevation
in the zoological scale.

The general principle is further illustrated by the
phenomena of submersion in animals in a state of hiber-
nation :

Exp. 5. I submerged a bat, which was lethargic
in an atmosphere of 36^* Fahr., in water of 40°. It
moved about a little, and expelled bubbles of air from
its lungs. It was kept submerged during sixteen
minutes, and was then removed. It appeared uninjured
by the experiment !

Exp. 6. I placed a hedgehog which had become so
lethargic in an atmosphere of 40° Eahr. as not to awake
to take food for several days, under the surface of water
at 42° Tahr. It moved about and expelled air from the
lungs. It was retained under the water during twenty-
two minutes. It was then removed. It appeared unin-
jured !

AND OTHER FORMS OF APNCEA. 13

These animals die as speedily as other warm-blooded
animals, if submerged in a state of activity.

Cases are recorded of the human subject being re-
stored after many minutes of submersion. It may well
be doubted whether the facts so recorded were correctly
observed. But if they were, it must be supposed that a
state of syncope, or of shoch, must have obtained at the
moment of immersion, and the circulation have been
reduced.

For here it may especially be said — cita mors venit —
aut victoria IcBta.

The great principle in regard to the duration of sus-
pended respiration without a fatal issue, is — the degree
of slowness of the hlood-poisoning process of the circu-
lation. Every thing which, within physiological limits,
conduces to this effect, prolongs life. Every thing which,
-without respiration, promotes the circulation, such as the
warm-hath, frictions, &c. leads to speedier blood-poison-
ing and death.

It must be remembered that the blood is poisoned
by carbonic acid, formed by and during the circulation,
and that there is one remedy, which consists in the elimi-
nation of that poison, and that this is — Besjoiration
alone.

14 POSTURAL RESPIEATION IN DROWNING

§ V. — The Effects of Apnoea chiefly the result of the
Retention of Carhonic Acid.

That the effects of apnoea are not the result of the ex-
clusion of oxygen, but rather of the retention of carbonic
acid, has been already stated in general terms, together
with the one sole efficacious mode of treatment deduced
from it. I now proceed to detail experiments, at once
full of the deepest physiological interest, and confirmatory
of this view.

Exp. 7. — A tame mouse was placed in two ounces of
nitrogen gas, not quite pure, as before : it soon began to
panty from re-respiring the exhaled carbonic acid, and
shortly afterwards to gasp, from the influence of the
action of the retained carbonic acid on the medulla ob-
longata; and mfive minutes it was dead.

Exp. 8. — I now placed another tame mouse in ten
ounces of the same gas : it remained in it during ffti/
minutes, neither panting nor gasping, its breathing be-
coming slower and feebler. It was removed, and seemed
not to have suffered materially. The residual gas instantly
and entirely extinguished a taper, flame and spark.

Exp. 9. — In another experiment, I placed a wild
mouse mfour ounces of similar gas. It began to pant
in three or four minutes, and to open its mouth a little
in three or four minutes more. It was then transferred
into eight ounces of fresh nearly pure nitrogen. It re-
mained in this gas thirti/ minutes, its respiration simply

AND OTHER FORMS OF APNCEA. 15

and gradually subsiding in depth and frequency to only
forty-eight respirations in a minute. We then removed
it, in a most feeble condition ; it seemed to recover, how-
ever, and the next day was lively ; but it died (of second-
ary apncea ?) on the third.

These experiments are amongst the most remarkable
in physiology, and suggest many curious reflections ;
nearly all the carbonic acid existing in the blood is ex-
haled ; and nearly all oxygen being excluded, little or no
further carbonic acid can be formed. Eespiration is
reduced to its minimum ; yet the animal lives, the blood
not remaining or becoming poisoned by its carbonic
acid. It is a condition resembling hibernation.

I reserve further observations on these and another
series of experiments for a memoir which I am preparing
for the Institute of France. My present object is to
present brief practical views ; my further object is to
treat the subject of respiration, and its partial or complete
and varied suspension, at greater length and in aU its
scientific relations.

An animal submerged in water dies very speedily,
poisoned by the carbonic acid contained in the blood ;
and the more speedily, the quicker the circulation and
the formation of that carbonic-acid poison. Gasping is
the premonitory sign of death.

An animal placed in a very limited portion of nearly
pure nitrogen gas dies in the same manner, but more
slowly, a part of the carbonic-acid poison being evolved
into that gas, dinA. panting precedes the gasping.

16 POSTUEAL EESPIBATION IN DROWNING

In a large portion of nitrogen gas^ not quite pure,
that is not quite without oxygen, or in a second portion
of this gas, the first having received the portion of
carbonic acid already formed in the blood, or nearly
so, and no further carbonic acid being formed for want
of oxygen, the animal, ceasing to experience the organic
changes of respiration, and losing its temperature, simply
slowly sinks and dies, without the premonitory panting
or gasping.

As natural respiration is the result of excitation of
the pneumogastric nerves of the air-cells by the evolved
carbonic acid ; panting is the effect of oi'^r-excitation of
these nerves by the carbonic acid evolved and by a
portion of this gas inspired ; whilst gasping is the con-
sequence of the carbonic acid retained in the blood and
brought by the circulation into contact with the medulla
oblongata and spinalis. None of these events occur in a
large or second portion of nearly pure nitrogen. The
carbonic acid formed and evolved becomes less and less,
with the gradual subsidence, therefore, of the acts of
respiration, for want of the evolved carbonic acid excitant.

The phenomena may be compared to the slow ex-
tinction of a taper in a limited portion of atmospheric
air.

These views are confirmed by the following expe-
riments in a limited and unlimited portion of oxygen,
the difference being the presence or absence of a notable
portion of cabonic acid.

Hxp. 10. — I placed a white mouse in about two ounces

AND OTHER FORMS OF APNCEA. 17

of pure oxygen gas : it breathed naturally, then panted,
then sighed, and then gasped. It was removed in twenty-
five minutes, and was slightly convulsed, and still gasped
when in the open air ; it tottered in its movements. The
residual gas brightened the sj)ark of a taper lighted and
blown out ; it therefore contained much oxygen, and the
phenomena were exclusively those of carbonic acid.

^xj). 11. — I placed a mouse in a large quantity of
pure oxygen gas : it remained during three or four hours
without manifesting any change, and was then removed
apparently little affected.

§ YI. — On the Influence of Temperature y and on the
Warm-Bath.

We owe our knowledge of the influence of tempera-
ture in apnoea to the splendid investigations of Ed-
wards, and to the more recent experiments of M. Brown-
Sequard.

Within certain limits, which may in general terms be
fixed at 60« and 100°, Pahr. the duration of hfe in the
case of suspended respiration is inversely as the tempe-
rature.

Above and below those temperatures respectively,
heat and cold have each a directly injurious effect.

In illustration of these facts, I here adduce two inva-
luable Talles, giving the results of the experiments of
Edwards and of M. Brown- Sequard :

18 POSTUEAL RESPIRATION IN DROWNING

E&wardis Tahlef^
Influence of temperature. — ^Kittens two days old
asphyxiated by immersion in water :

Mean duration of life.

At 32° Palir.

4' 33"

50°

10' 23"

68°

38' 45"

784"

34' 30"

86°

29'

106°

10' 27"

M. Brown-Sequard* s Table.f
Influence of previous temperature. — Rabbits two days
old immersed in water of 77° Fabr. being first cooled:

Mean duration of life.

To 96° Pabr. 12'

85° 18i'

74° 23'

65° 28'

It is obvious that the continuous warm-bath, taken
alone, must be utterly excluded in the treatment of
apnoea — that it can only be considered as admissible
when respiration is either not extinct or admits of being
excited, or is effectually imitated artificially.

There is, however, a use, not indeed for the conti-
nuous warm-bath, but for the sudden kot-h&th, not

* Des Agens Physiques ; p. 630 — .
t Researches, New York, 1853, p. 47.

AND OTHER FORMS OP APXCEA. 19

hitherto suggested for adoption in practice : it is when
it is of such elevated temperature, and when the patient
is in such a condition, as to admit of its being made an
excitant of resjnration.

Its use in this point of view is chiefly useful in the
apnoea of still-born infants; and I shall have to treat
of it in this relation hereafter. But it cannot be
doubted that, if it could be made available at the moment
the patient is rescued from the water, a sudden momen-
tary plunge into a bath of from 100® to 104° Fahr.
would prove the most powerful excitant of inspiration.

But, even in this case, the application of the hot-bath
must be momentary, and alternated with that of the cold
bath or douche of the temperature of 50° or 60° Pahr. as
an excitant of respiration in its turn.

This suggestion I made some years ago to my much-
lamented friend, Mr. Henry Smith, who, in one case, the
only one on record, used it in the case of a still-born in-
fant, with complete success.

"We must cease therefore from the empirical use of
the warm-bath. When tliis agent is used, it must either
be administered as an excitant, not of the circulation, but
of respiration ; or as an excitant of the circulation, res-
piration being already restored, excited, or adequately
imitated.

In confirmation of these results, I may here adduce
four experiments, performed at the Eoyal Humane So-
ciety's receiving house in Hyde Park, and witnessed and
recorded by Mr. "Williams, its superintendent :

20 POSTURAL RESPIRATION IN DROWNING

Tlxp. 12. — A kitten, three days old, 98° Pahr. in
temperature, was submerged in water of the same tem-
perature. Its last gasp was at the termination of 144
minutes.

Exp. 13. — A kitten of the same age, after exposure
alone to the cool atmosphere, was immersed in water of
50° Fahr. It survived 23 minutes !

Hx/p. 14. — We submerged a puppy, 66 hours old,
under water at 100° Falir. It endeavoured to escape ;
became still ; then continued to gasp, frequently and
quickly, during 19' 35" : we counted 16 gasps.

Exp. 15. — ^We submerged a puppy of the same litter
in water of 50° Fahr. It endeavoured to escape ; became
stiU, but in a less marked manner than the former one ;
gasped more slowly and at longer intervals during 39' 35" !
In this case we counted 24 gasps.

Judging from the Tahle of Edwards, the animal would
have lived longer still in a temperature of 60° Tahr. ;
this temperature acting in prolonging life in apncea,
whilst that of 50° destroys life as the direct effect of cold.

§ VII. — The former Modes of Treatment of Asphyxia.

The modes of the treatment of asphyxia hitherto pro-
posed cannot be stated more distinctly than by the sub-
joined quotation of the latest Rules proposed by the
Eoyal Humane Society :

AND OTHER FORMS OF APNCEA. 21

" To Restore the apparently Drovmed.

" 1. Convey the body carefully, with the head and
shoulders supported in a raised position, to the nearest
house.

" 2. Strip the body and rub it dry; then wrap it in
hot blankets and place it in a warm bed, in a warm cham-
ler free from smoke.

" 3. Wipe and cleanse the mouth and nostrils.

" 4. In order to restore the natural vjarmth of the
body — move a heated covered warming pan over the
back and spine.

" Put bladders or bottles of hot water, or heated
bricks, to the pit of the stomach, the arm-pits, between
the thighs, and to the soles of the feet.

" Foment the body with hot flannels.

" Eub the body briskly with the hand ; do not, how-
ever, suspend the use of the other means at the same
time ; but, if possible, immerse the body in a warm-bath
at blood heat, or 100° of the thermometer, as this- is pre-
ferable to the other means for — restoring warmth,

" 5. Yolatile salts or hartshorn to be passed occa-
sionally to and fro under the nostrils.

"6. No more persons to be admitted into the room
than is absolutely necessary."

These Rules may be summed up in one word —
warmth ! The idea is repeated no less than eight times.

22 POSTUEAL EESPIRATION IN DROWNING

In addition to these measures, others are also recom-
mended, and especially Lero/s mode of inducing artificial
respiration by means of a bandage, so appHed to the
thorax as to admit of being tightened and relaxed.

§ VIII. — Reflections.

But it will be sufficiently obvious to those who have
read the preceding pages with attention, that our main
objects in treating asphyxia are two : 1, to eliminate the
carbonic-acid poison already formed in the blood; and
2, to check as far as possible its further formation.

The utility of an emetic, as the first means of treat-
ment in stomach-poisoning, is not more obvious than the
instant institution of artificial respiration, the sole elimi-
nator of the blood-poison, in apnoea; and as in the
former we would not administer a new dose of the poison,
so in the Jatter we must not, if we could, prematurely
accelerate the circulation of the blood — that is, ih.Qfor7n'
ation of additional poison, by warmth, the warm-hath; &c.

Without due artificial respiration, every means of
augmenting the circulation must be injurious. Excited
or imitated respiratory movements are the sole means of
ehminating the carbonic-acid poison from the blood — the
unicum remedium in apncea; and whatever part the
want of oxygen plays in the state of things which exists
in apncea, in addition to the excess of carbonic acid, it
is still by respiration alone that it can be supplied. The
warm-bath and the other measures for restoring the cir-

AND OTHER FORMS OF APNCEA. 23

culation, without this as the constant and preliminary
measure, if they have any influence at all, can only aug-
ment the formation of the poison.

These latter measures must therefore be delayed.
T\\Q first, the sole first, remedy is — artificial respiration.

But the modes hitherto proposed for the institution
of respiration are, for reasons which I proceed to give,
either inefficient or absolutely injurious.

These modes of inducing artificial respiration are of
two kinds : the first may be compared, in its operation,
to the action of \h.Q forcing -pump ; the second, to that of
the suction-pump ; and both have been used ^vith a dis-
regard to the all-essential consideration of posture.

To commence my observations on this last point, I
must remark that when the subject is kept in the supnne
position, events occur which render every attempt at in-
ducing respiration absolutely nugatory : the tongue may
fall backwards, carry with it the epiglottis and close the
glottis or entrance into the windpipe and air-passages f
Fluids already in the mouth and fauces, or regurgitated
'^rom the stomach, may not only obstruct the air-passages,
but be forced or drawn into the windpipe, and so add a
new source of apncea ?

These obstacles are obviated at once by reversing the
position from the supine — to the prone !

Mr. Wilhams, the Society's Superintendent in Hyde
Park, has observed the cheeks to become inflated and air
to escape from the intestine, in cases in which artificial

24 POSTURAL RESPIRATION IN DROWNING

respiration has been attempted by the bellows ; and it is
certain that the plan of Leroy can have little efficacy.

The following experiment has been repeated many
times, and has been witnessed by George Webster, jun.
Esq. of Peckham, Mr. Williams, and other gentlemen :

Exp. 16. — The dead subject being placed in the
supine position, and pressure made on the sternum and
ribs, a little gurgling was heard in the throat ; but, the
pressure being removed, there was no evidence of ^%spira-
tion. The subject being then turned into the prone
position, and pressure being made on the spine and the
ribs, and removed as before, there was in general free
^:rpiration and ^Vzspiration,

One object of the succeeding section will therefore be
to describe and recommend the plan of jorowe-respiration,
or PRENOPNGEA (from •n^yivfi^, pronus).

But another objection applies to the mode of inducing
artificial respiration having the character of the forcing-
pump.

In order to accompHsh this kind of respiration, a
degree of force must be used, sufficient to raise the bony
and other structures of the thorax, and depress the dia-
phragm— a degree of force which both anticipation and
experience prove to be injurious to the delicate structure
of the lungs. Legallois and M. Leroy found these struc-
tures variously lacerated by this measure in experiments
on animals — the air so impelled sometimes passing into
the capillary vessels, and sometimes even into the cavity
of the thorax !

AND OTHEU FOUMS OF APNGEA. 25

Two facts are obvious from the considerations laid
before the reader in this and the preceding sections : the
first, that artificial respiration must precede and accom-
pany all other measures for the recovery of the patient
affected by the suspension of this vital function; and
the second, that some other modes of artificial respiration
than those hitherto proposed must be devised, before we
can be said to treat the case on scientific grounds, or in
a safe and efficient manner.

I must add, that any measure of inducing the arti-
ficial inspiration of air, if used with too great rapidity j
is apt to close the larynx by external pressure on its
sides :

Hxp, 15. — ^I removed the larynx and windpipe, and
attached the nozzle of the syringe to the lov/er part of
the latter : on drawing up the piston, the cordse vocales
were seen to be drawn together whenever the piston was
moved with some degree of rapidity, and all ingress
of air into the windpipe utterly prevented !

The obvious conclusion is, that, whenever we attempt
artificial respiration, the procedure must be effected with
gentleness and slowness.

§ VIII. — New Modes of Treatment of Apnrna.

The reader of the preceding section will readily anti-
cipate the principal points in this.

The patient is to be taken from his former supine
position and laid prone on Msface^

26 POSTURAL RESPIRATION IN DROWNING

In tills jJositio7t, the tongue falls forwards, draivs
with it the epiglottis, and leaves the glottis open, whilst
all fluids will flow from the fauces and mouth. The
tongue may even be drawn forwards, to secure its
removal, and that of the epiglottis, from the rima glottidis.

In order that the face may not come into contact
with the ground, the patient's wrist is to be carried
upwards and placed under the forehead.

It will now also be perceived that the thorax
and abdomen will be pressed by a force equal to the
weight of the trunk. This pressure will induce e;rpiration.
And, additional pressure being now made on the posterior
part of the thorax and abdomen, the expiration will be
more complete.

This latter pressure is to be then removed. Its re-
moval will be followed by slight i^^spiration. The weight
of the body is then to be removed from the thorax and
abdomen, by gently turning it 07i the side and a little
heyond, placing one hand under the shoulder and the
other under the hip of the side moved. In this manner
a fair degree of i^^spiration is induced ! And thus, with-
out instruments of any kind, and with the hands alone,
if not too late, we accomplish that respiration which is
the sole, hut sure effective means of the elimination of
the blood-poison !

Por some experiments on this mode of inducing arti-
ficial respiration, which I designate postural respiration,
or THESIOPNCEA (from Bea-iq, positio), I am indebted to
Edward Long Fox, Esq. of Bristol. They were per-

AND OTHER FORMS OF APXCEA. 27

formed by that gentleman, with the aid of Mr. Charles
Hunter and Mr. E. L. Bowles, at St. George's Hospital.

JExp. 17. — "The recently dead body was placed in the
jprone position; as this was done, considerable expiration
took place. Pressure being made on the back and ribs,
further expiration took place, but only to a slight extent.
On removing this pressure, slight inspiration took place.
On turning the body on the left side, violent inspiration
took place, which ceased as the body was turned beyond
the quarter of a circle.

" Tlie body was again pronated and again rotated.
The expiratory and inspiratory effects were most marked.
On one occasion, 120 bubbles of air (in a bent glass
tube through which the patient breathed) were distinctly
counted during one expiration; and the ins])iration
seemed to be quite in an equal degree, although, from
its greater rapidity, the bubbles could not be counted.''

lExp, 18. — "The body was turned into the prone posi-
tion : considerable expiration took place, which was
much augmented by the pressure of tJie hands on the
back. On removing the pressure, a little inspiration
took place. The body being then rotated on the right
side, considerable inspii'ation took place, whilst moving
through one fourth of a circle; on continuing the ro-
tation, inspiration continued until the body was half
way between the table and the lateral position, when it
ceased."

Exp, 19. — "The subject, a girl, aged 5 years. On

c 2

28 P0STUE.1L EESPIRATION IN DROWNING

pronation of the body, air was expelled in considerable
quantity throngh the water in the inverted glass siphon.
On rotation, air entered to a corresponding amount.
This was repeated 7 or 8 times.''

The efftcacy of rotation was again manifested in a
subsequent experiment witnessed by Mr. Williams.

Exp. 20. — In some experimements made at the St.
Mary-le-bone Infirmary, already noticed, the dead subject
being first placed on the bacJc, and pressure made on the
thorax, a little expiratory noise was made; but there
was no inspiration on its removal; the subject being
turned i?ro7^e on the face, both expiration and inspiration
were distinctly observable on making and removing pres-
sure along the course of the dorsal spine.

This manoeuvre must therefore be added to rotation :
when the patient is laid quite prone, gentle pressure
maybe made on the spine and ribs ; this being removed,
the patient may be rotated; and so on systematically.

These changes should be alternated at the rate of
about sixteen times in a minute, and not more, and gently
and equably.

It is scarcely necessary to add that this mode of res-
piration must be long and perseveringly pursued ; and
now that respiration is being accomplished, every other
means of respiration mai/ he superadded.

Sufacient has been done to show the practical utihty
of this, the only certain, safe, and efiicacious mode of in-
ducing artificial respiration; but it is obvious that it

AND OTHER FORMS OF APNGEA. 29

still remains to ascertain the exact value of this and of
other measures for succouring the patient affected by
apnoea, not by what is fallaciously called experience, but
by a series of careful and comjoarative experiments.

The clothes of the patient may meantime be changed
for others warm and dry, which must be contributed by
the bystanders. Por I must now observe that I have
all along supposed the patient taken out of the water
at a distance from medical or other assistance, except
that which benevolent persons accidentally near the spot
may be able to afford ; for no time must be lost by his
removal.

All who are so present should be instantly employed :
the most able in effecting respiration ; of the rest, four
should sieze the limbs with their hands and rub them
with firm pressure upwards. The warm-bath is not to
be compared with this mode of restoring warmth and
improving the circulation, if it be pursued with energy.
The blood is driven upwards, and though at first venous,
mai/ stimulate the heart.

But I must repeat that aU these modes of procedure
must be held as perfectly suhsidiary to the one only
remedy, prone and postural respiration. There is one
hope, and only one hope ; one remedy : it consists in
eliminating the carbonic acid blood-poison from the blood
by respiration.

Having thus given in detail my views of former
modes of procedure and of some new ones, I now proceed
to place before my readers a recapitulation of the

30 POSTURAL RESPIEATION IN DROWNING

treatment to be systematically adopted in apncea, in the
form of Rules, which, I humbly think, may with great
advantage be substituted for those formerly recommended :

§ IX. — New Rules for the Treatment of Asphyxia,

The Rules for the treatment of asphyxia may be
divided into two series :

1. The essential, or the means to be adopted

in every case ;

2. The occasional, or the means to be further

tried when convenient.

I. Rules to he adopted in every case :

I. Send with all speed for medical aid, articles of
clothing, blankets; &c. but

II. Lose not a moment of time ; treat the patient on
the spot, in the open air, exposing the face and chest

freely to the breeze (except in too cold weather) ; then —

To excite Respiration —

III, Place the patient gently and for a moment on
the face, to allow any fluids to flow from the mouth ;

AND OTHER FORMS OF APNGEA. 31

lY. Then raise the patient into the sitting posture,
and endeavour to excite respiration —

1. By irritating the nostrils by smiff; hartshorn; &c.

2. By irritating the fauces by d^ feather ; &c.

3. By dashing hot and cold water alternately on

the face and chest. If these means fail —

To imitate Respiration —

V. Eeplace the patient on his face, his wrist under
his forehead [vide frontispiece), and —

1. Turn the body gradually, but completely, on

the side, and a little more ; and then again
on the face, alternately ;

2. "When replaced; apply pressure along the

back and ribs, and then remove it, and
proceed as before ;

3. Let these measures be repeated gently,

deliberately, but efficiently, and perse-
veringly, sixteen times in the minute.

YI. Continuing these measures, rub all the limbs
upwards, making firm pressure, energetically,

YII. Replace the wet clothes by such other covering,
&c. as can be procured.

Omit the warm-bath until resj)iration be re-established.

32 POSTURAL RESPIRATION IN DROWNING

II. Further Rules, to he adopted when convenient :

I. Apply galvanism ;

1. Along the diaphragmatic nerve, or

2. Through the diapliragm and intercostal

muscles ;

II. Induce the inhalation

1. Of oxygen ;

2. Of dilute pure ammonia.

On the first part of these Eules no further explanation
is necessary. On the second, I now propose to make a
few concluding observations.

Of the value of galvanism I have not formed a very
high opinion. If the current be passed along the dia-
phragmatic nerve, or through the diaphragm itself, or
through the intercostals, respiratory movements may be
excited. But I do not know that they would possess any
advantage over similar movements induced in any other
way.

It is stiU a question whether the action of the heart
may be beneficially excited by galvanism. But the care-
ful experiment should be tried.

The galvanic current passed through the limbs would
excite their muscles to contract, and so induce the propul-

AND OTHER FORMS OF APNCEA. 33

sion of the blood along the veins. Whether this mode
of promoting the venous circulation would possess any
advantage over the mode by friction and pressure, requires
to be determined by experiment.

I cannot regard the inhalation of oxygen as a very
promising measure. Its value requires to be submitted
to much further trial and investigation.

The inhalation of dilute pure ammonia appears to
me to have more in it of promise. The blood is over-
charged with carbonic acid : the inhalation of ammonia
would neutralize this carbonic acid and form the car-
bonate of ammonia; the carbonic acid is the blood-poison;
the carbonate of ammonia is free from any deleterious
quality.

It cannot be repeated too often or too earnestly that
aU these remedies of the second class, if I may so desig-
nate them, must be regarded as entirely subsidiary to the
constant persistence of respiration.

The Warm-Bath.

It will be seen that I have entirely omitted the use of
the warm -bath.

This measure is perfectly useless, not to say injurious,
unless artificial respiration be simultaneously administered;
and this administration is incompatible with the posture
implied by the use of the warm-bath. To use the warm-

34 POSTURAL RESPIRATION IN DROWNING

lath is, therefore, to renounce the only hojoe, the only

remedy m apnoea.

It is true that the warm-bath has been commended
by some of the members of the Royal Humane Society ;
but it is as emphatically condemned by the Superin-
tendent of the Society at Boulogne, by theory, and
by experiment.

Experiment proves, as seen in the Tables adduced
(pp. 18), from Edwards and M. Brown -Sequard, that
life is more protracted in the case of suspended res-
piration at cool temperatures than in temperatures more
elevated ; and the experiments given, p. 19, 20, were per-
formed at the Eeceiving House in Hyde Park, the first
two being witnessed by the Secretary of the Society and
by Dr. Christian.

An animal lives longest without respiration in a tem-
perature of about 60° Fahr, With respiration, the
temperature may be carefully raised to 98°.

§ X. On the A^mo^a of Still-born Infants,

The difference in regard to the power of supporting
the suspension of respiration in the young animal before
and after the commencement of respiration has been
noticed by the illustrious Harvey, by Buffon, by LegaUois,
by Edwards, &c. The same difference obtains in regard
to the very young and the less young of certain species
of animals which have breathed.

AND OTHEU FORMS OF APNCEA. 35

We all remember the celebrated question of Harvey,
and the equally celebrated experiment of Buffbn. The
foetus breathes less, developes less heat, and supports
suspension of respiration better than the infant. It
supports apnoea proportionably longer.

The differences in regard to age in rabbits is shown
in the following beautiful Table of Legallois :

Legalloii Table,

Influence of age upon the duration of life. Rabbits
asphyxiated by immersion in water.

Gaspings.

27'
16'
5i'
4'
3i'
2|'
2i'

The same fact is observed in puppies and kittens.
The guinea-pig is, however, an exception to the rule;

* Legallois observes (Ed Paris, 1812, p. 79) — J'essaye la sensi-
bilite en pinQant les oreilles, les pattes et la queue, et j'en note
I'extinction au moment ou ces pincements ne determinent plus aucun
mouvement." " Assez souvent il existe encore un peu de sensibility
a I'anus, quand il n'y en a plus dans ces parties." — Phenomena, in
fact, not of sensibility, but of reflex action.

)ays old.

Sensibility'

1

15'

5

10'

10

44'

15

3'

20

2i'

25

2'

30

W'

36 POSTURAL RESPIRATION IN DROWNING

the very young of this species holding nearly the same
rank in this respect as the adult.

In regard to the human subject, we learn from the
experiments of MM. Andral and Gavarret that the quan-
tity of carbonic acid exhaled in respiration «V^creases from
the age of eight to that of thirty years ; apncea will of
course be the more promptly fatal in the inverse order.
After the age of thirty, the quantity of the carbonic acid
poison ^^creases.

The male subject exhales more carbonic acid than the
female, the robust than the feeble, and will consequently
perish more promptly by the suspension of respira-
tion; a result the opposite, I believe, to the popular
opinion.

In treating the still-born, the first great object is, as
usual, to excite respiration ; this is most effectually done
by plunging it into a cold ( — not a warm bath — ) and a hot
bath alternately. This means of exciting respiration in the
still-born infant was first put to the test of experiment,
at my suggestion, as I have already stated, by my late
deeply regretted friend, Mr. Henry Smith.

The just temperatures of these baths have not yet
been ascertained. I would suggest from 50° to 60*^ Fahr.
for the cold, and from 98° to 102° Pahr. for the hot
bath. The immersion should be momentary ; the alter-
nations quick.

If this means fails,— if irritation of the nostrils, the
face, and the general surface, has been tried in vain — not
a moment is to he lost, but respiration must be imitated in

AND OTHER FORMS OF APNCEA. 37

the manner already described — the jr/'o?ie position being
first adopted, and then postural-iesT^irdLtioJi being fully
and perseveringly instituted.

§ XI. — 0/t Secondary Apncea.

All is not safe even when the patient seems to be
restored from apnoea.

One of the^puppies of Buffon's experiment died some
time afterwards on the same day.

On one occasion I placed a sparrow and a mouse in
the same limited portion of atmospheric air. After a
time, the sparrow began to open its mouth and gasp, and
was removed ; and after a longer interval, the mouse pre-
sented the same phenomena, and was removed in its turn.
The bird died the next day ; the mouse on the second
following day — of secondary apncea.

Sir Humphry Davy was seized with alarming sym-
ptoms on the evening of the day on which he had
attempted to breathe carburetted hydrogen gas.

On one occasion a soldier was taken out of the
Thames in a state of apnoea. Animation was restored.
But, many hours afterwards, he was seized with convul-
sions and expired.

From these and other similar facts we must deduce
the conclusion, that our watchful care and our remedies
must be continued after apparent danger is over. There
is still a hidden and remoter danger ; the consequence of
the poisoned state of the blood — of secondary apnoea.

38 POSTURAL RESPIRATION IN DROWNING

The patient should be kept in a cool atmosphere,
exposed to the breeze, and be made to take deep and free
inspirations voluntarily, and active exercises should, as
far as possible, be enjoined, in order that the blood may
be purged of its carbonic-acid poison, whilst its circula-
tion is promoted. Carbonic acid in the Hood does not
excite respiration until it exists in sufficient quantity to
induce gasping by acting centrically on the spinal marrow.
It is its presence in the air-cells which induces inspiration
and panting, as a reflex phenomenon. Its elimination,
therefore, requires voluntary, excited, or artificial respira-
tory movements.

But the specific antidote to this blood-poison is — the
free inhalation of dilute pure ammonia. This gas actually
neutralizes the carbonic poison in the pulmonary blood.

§ Xn. — Recapitulation,

1. The movements in normal respiration are reflex
or d^iflstaltic;

^. The respiratory movements in apncea are direct
or ecstaltic;

3. The former are excited by the carbonic acid ex-
haled from the blood into the air-cells, in contact with
the filaments of the pneumogastric nerve ; and

4. When this carbonic acid is in excess, it induces

AND OTHER FORMS OF APNCEA. 39

5. The latter are excited by the carbonic acid retained
in the blood and brought into contact with the medulla
oblongata and medulla spinalis ;

6. They take the specific form of gasping, with jerks
and tottering movements, and eventually of paraplegia ;

7. The carbonic acid retained in the blood acts as %
most deadly poison ; there is one mode of eliminating
this poison, — Eespiration, — and one sure mode of in-
ducing respiration — ■pronation and rotation of the body.

Respiration- is to the Carbonic-Acid Poison in the Blood,
what Vomiting is to Poison in the Food.

8. The quantity of this carbonic-acid poison formed
is proportionate to the rapidity of the circulation; to
augment the circulation vnthout effecting the elimination
of the poison by artificial respiration, as by the warm-
bath, is to augment the quantity of the poison, and to
accelerate the death of the patient !

9. In order to effect artificial respiration, it is essen-
tial to place the patient in the prone position; otherwise
the tongue and any fluid in the mouth fall backwards
and close the glottis or entrance into the windpipe ;

10. In adopting the prone position, a degree of pres-
sure is at the same time made on the thorax and abdomen
equal to the weight of the trunk of the body, and ex-
piration is produced ;

40 POSTUEAL RESPIRATION IN DROWNING

11. A little pressure now made along the spine aug-
ments the expiration ;

12. On removing this pressure, inspiration com-
mences ;

13. And by gently rotating the body on the side,
further inspiration occurs :

14. By repeating these manceuvres we produce the
most efficient artificial respiration — the only effectual
means of treatment ; they have never failed us /

15. When artificial respiration is thus effected, and
the carbonic-acid poison is thus eliminated from the
blood, the application of friction with pressure along the
veins, and of warmth, may be superadded ;

16. The warm-hath, excluding prone and postural
respiration, should only be administered when the res-
piration is either not suspended, or when it is perfectly
restored.

Lastly, I must repeat that the foregoing pages are a
mere Abstract of a considerable investigation scarcely
more than just begun. Much remains to be done.

§ XIII.— T/^^ Royal Humane Society.

Such is very nearly the Essay which I presented,
first in manuscript and then in print, to the Royal Hu-
mane Society, in. January, 1856, and of which the follow-
ing notice occurs in the Society's Report :

" Dr. Marshall Hall, a Member of the Committee,

AND OTHER FOEMS OF APNCEA. 41

has just presented to the Society a manuscript copy of a
' Treatise on Asphyxia ; being an abstract of an inves-
tigation of its nature, carbonic-acid blood-poisoning, and
its remedy, prone and postural respiration/ He is also
having it printed at his own expense, with a view of
supplying the Committee with a sufficient number of
copies for the purpose of being sent to all the Medical
Assistants of the Society ; for which he has received the
thanks of the Committee, for the lively interest he has
thereby evinced in the objects of the Society." — Report^
p. 24.

I earnestly requested that a sub-committee might be
appointed to witness the development of the beautiful
results of postural respiration — but in vain !

Mr. Williams once witnessed an experiment at St.
George's Hospital, and I add his account of it ; it was
made before the Vimometer used in the subsequent ex-
periments was invented. The apparatus consisted of
an elastic tube, furnished with an inverted siphon con-
taining a little water, to indicate the flow and reflux of
the air, induced by rotation and pronation.

" Attended at St. George's Hospital, to witness some
experiments made on the new method of producing
artificial respiration without the aid of bellows, pro-
posed by Marshall Hall, M.D. &c.

" The mouth and one nostril were carefully closed by
means of sticking-plaster, to prevent the possibility of

42 POSTUEAL RESPIRATION IN DROWNING, ETC.

air finding its way through them. In the other nostril
was inserted a caoutchouc tube, about three feet long, at
the end of which was fixed a bent glass tube of the same
size, into which was poured a teaspoonful of water.

" The operator then took hold of the subject (which
was lying in the prone position) by the left shoulder and
hip, and gently raised it, until the whole body was resting
on the right side. This movement caused the air to enter
the glass tube, creating bubbles in the water as it passed
on into the lungs ; and on the body being slowly replaced
on the stomach, the air was freely expelled from the
lungs, and caused the same agitation in the water as it
made its exit through the glass tube.

" Judging from the agitation of the water, the quan-
tity of air which passed into the lungs must have been
considerable, and quite sufficient for the purpose of arti-
ficial respiration.

" The great advantage of inflating the lungs by means
of the rotatory movement, or raising the body by the one
shoulder and hip, is the readiness with which one person
can perform the operation, in the absence of any other
assistance.

" This experiment appeared to be perfectly satis-
factory.

" Herbert Williams,

" Superintendent R. H. S. Hyde-park Receiving-house.
" Feb. 6, 1856."

PART SECOND.

IF OCR PATIENT BE DYING FROM COLD, DO WE NOT CAFTIOtTSLY ADMINISTBR
WARMTH? OR IP HE BE READY TO PERISH FROM WANT OF FOOD, DO WE NOT
ADMINISTER FOOD ? AND SHOULD HE BB IN PERIL FROM WANT OF AIR, SHALL
WB NOT ADMINISTER AIR ? WOULD THE WARM-BATH SUFPL1 THE PLACE OF
FOOD? NEITHER CAN IT SUPPLY THE PLACE OF AIE.

PART SECOND.
POSTURAL RESPIRATION

IN

DROWNING,

§ I. — The 'Royal Humane Society.

A YEAE has rolled round, and the Eeport of this
Society for 1857 contains the following paragraph :

" The Governors will remember that in last year's
Eeport it was announced that Dr. Marshall Hall had
presented to the Society a new Treatise on " Asphyxia,"
of which work he subsequently presented to the Society
a sufficient number of printed copies to enable the Com-
mittee to transmit a copy to each of the Societ/s Medi-
cal Assistants, and which they accordingly did, accom-
panied by a circular letter calling on each to give his
opinion on the proposed new methods of treatment.
Ten replies thereto have been received, including one
from Sir Benjamin Brodie, and one from Dr. Christian,
M.D. acting Surgeon to the Societ/s Receiving House,
Hyde Park ; and from the preponderating opinions ga-
thered therefrom, the Committee are advised to pause
before adopting this new method recommended by Dr.

46 POSTURAL RESPIRATION IN DROWNING

Marshall Hall, until it has been proved by the test of
successful experience." — Rejwrt, p. 27.

Any thing more insidious could not be penned !

And on what question, in reality, does the Committee
pause ? Their patients are dying for want of respiration ;
the safe and effectual means of administering this res-
piration are placed in their hands ; and they pause as to
whether they will allow the patients to use them ! — as to
whether they will allow the patient dying for want of air
to have air administered to him !

The delay is homicidal.

There is no need of a " successful experience" in a
matter so simple ; but if there were, it has been afforded
by the cases recorded in the Lancet during the year
which has intervened between the dates of the Society's
two Reports.

It is a question for unsophisticated common sense.

But what are those untoward reports? Why are
they not published ? It is surely a question in which
the public and the profession are deeply concerned.

Dr. Christian, acting Surgeon to the Society's Ee-
ceiving House, Hyde Park, is mentioned as one having
sent in a report. But it was Dr. Christian who proposed
first to try " removal, the warm-bath, and galvanism \'
and then, when the apncea, however hopeful, tnust have
passed into hopeless asphyxia, to institute postural res-
piration !

Dr. Christian introduces the following new Eule I,
without acknowledging its author :

AND OTHER EORMS OP APN(EA. 47

" Lift the hod/ij out ofthewatet^^ (of the warm-bath),
" the necJc and chest being bare, and dash cold water
suddenly against the face, neck, and ehest.'^

This is the alternate application of heat and cold, which
was first proposed by me, and first carried into effect by
my friend Mr. Henry Smith, in the treatment of the still-
born infant, and given in the Essay presented to the
Society, in the following terms :

" There is, however, a use, not indeed for the warm
bath, but for the hot bath, not hitherto suggested for
adoption in practice : it is when it is of such elevated
temperature, and when the patient is in such a condition,
as to admit of its being an excitant of respiration.

" Its use in this point of view is chiefly useful in the
asphyxia of new-still-born infants ; and I shall have to
treat of it in this relation hereafter. But it cannot be
doubted that, if it could be made available at the moment
the drowned patient is rescued from the water, a sudden
momentary plunge into a bath of from 100° to 104° Fahr.
would prove the most powerful excitant of inspiration.

" But, even in this case, the appHcation of the hot-
bath must be momentary, and alternated with that of the
cold-bath of 50° or 60° Falir. as an excitant of respiration
ill its turn.

" This suggestion I made some years ago to my
much-lamented friend, Mr. Henry Smith, who, in one
case, the only one on record, used it in the case of a still-
born infant, with complete success.

48 POSTURAL RESPIRATION IN DROWNING

" We must cease therefore from the empirical use of
the warm-bath. When this agent is used, it must either
be administered as an excitant, not of the circulation, but
of respiration ; or as an excitant of the circulation, res-
piration being already restored, excited, or adequately
imitated."

I dismiss this very painful subject by adducing Dr.
Christian's proposition entire, leaving it to the judgment
of my readers :

" Rules for treating Persons Asjphyxiated.

" 1. Convey the body rapidly to the house, the head
and shoulders raised.

" 2. Place it at once in the warm bath at 100°, up
to the neck.

" 3. Lift the body out of the water, the neck and
chest being bare, and dash cold water suddenly against
the face, neck, and chest.'' (See above, p. 47, 1. 1.)

" 4. Pass pure ammonia under the nose.

" 5. Use artificial respiration, the patient being held
in the upright position.'' (How ?)

" 6. Pass the galvanic current through the chest,
including the diaphragm and the muscles of respiration.

" 7. These methods should occupy but a few mi-
nutes ( ! ) ; if they fail, place the patient on the floor"
(why on the floor ?), " and use the ^ Ready Method'
according to the printed directions, fully and effi-
ciently." ( ! )

AND OTHER FORMS OF APNCEA. 49

But it must be remembered that nearly the first lines
of that ready method are —

" Lose not a moment of time, treat the patient on the
spot J in the open air, exposing the face and chest freely to
the breeze."

As to our " experience," I must observe tliat there
2LYQfour distinct stages of apnoea :

1. The first, that in which there are still slight
signs of respiration ;

2. The second, that in which respiration has entirely
ceased, but may be excited by proper excitants ;

3. The third, that in which no excitant can excite
respiration ; and

4. ^\\Q fourth, true asphyxia.

It is absolutely necessary to keep these distinctions
in view, in judging of the efficacy of remedies, in order
that we may compare similar cases ; and this has never
been done. Our ^^ experience^' therefore is 2, fallacy.

If this were done, it would still be necessary to com-
pare similar cases in sufficient mnnher ; and this has
never been done, and indeed probably never will be done ;
again therefore our pretended " experience"^ is 2, fallacy.

And thus it has happened that the continuous warm-
bath, which must be injurious, has been supposed to be
beneficial !

But I proceed to details of far greater weight and
importance than this very useless controversy.

D

50 FOSTUEAL RESPIRATION IN DROWNING

§ II. — More detailed Rationale of Apnoea.

Before we can be perfectly prepared to investigate
the nature of apncea, its effects, and its remedies, we must
study the special function which is interrupted.

Respiration involvesybwr important processes :

First ; oxygen is absorbed by the blood circulating
in the pulmonary blood-channels, — only absorbed, — from
tlie w^spired atmospheric air.

Secondly ; by this oxygen the carbonic acid is dis-
placed and evolved from the blood, and removed from
the system with the ^^cpired air.

Thirdly ; aqueous vapour in large quantity is evolved
from the pulmonary blood, and exhaled with the same
expired air.

Fourthly ; the expired air has a higher temperature
than the inspired air ; caloric is therefore given off by
rhe pulmonary blood, the temperature of which is pro
tanto diminished : — respiration is therefore a cooling
process.

The panting of the dog from excessive heat is doubt-
less a cooling process, and its final object to keep down
the temperature.

The cooling effect of artificial respiration led in certain
experiments to erroneous conclusions in regard to the
source of animal heat.

The trachea is not only the way of ingress into the
lungs, but the way of egress from the lungs ; it is not

AXD OTHER FORMS OF APNCEA. 5 J

only the ventilator by which the atmospheric air, and
especially its oxygen, is admitted, but the chimney by
which the air expired is, with its accession of carbonic
acid, conveyed from the lungs, — that carbonic acid which
would, if retained, be a real '' choke-damp,'' as it is the
blood-poison, and the real cause of death, in apnoea.

The important function of respiration consists in this
inhalation of oxygen and exhalation of carbonic acid.
This function is unattended by any important change of
temperature. Animal heat is evolved not in the lungs,
hut in the general system at large, where the change of
oxygen into carbonic acid, the slow combustion of carbon,
takes place, during the processes of deposition and ab-
sorption in which nutrition consists.

That nutrition, and with it the evolution of heat, are
events which occur in the systemic circulation, are facts
principally established in modern times ; but not entirely ;
they were not unknown in the time of Harvey. I find
the following remarkable passage in a " Discourse"' ap-
pended to his English edition of Harvey^s " Anatomical
Exercises concerning tlie Heart and Blood,'^ by Dr. James
de Back, which appeared in the year 1653, p. 107 :

" I doe believe, that wherever nutrition is performed,
there this function is most manifestly executed, and that
the parts, whilst they are nourished, are heated ; there
the composition of the blood is dissolved, and is divided
very small; there also i\\Q firie particles, freed from their
fetters, and being united, do show their force by
heating."

D 2

52 POSTURAL RESPIRATION IN DROWNING

That the function of respiration is in reality a cooling
process, was the doctrine of Galen [Be Utilitate Respira-
tionis, ed. Yen. 1597, p. 223). It was also the doctrine
of Haller; and it is obviously true. We may inhale
the atmospheric air at various temperatures, some of
which are below that of freezing water ; we exhale it
at the temperature of 92° or 94° Eahr. — a temperature
comparatively higher even in summer, and still more con-
siderably so in winter. This elevation of temperature
in the expired air is effected by a proportionate loss of
temperature sustained by the blood circulating in the
pulmonary blood-cliannels. Respiration is therefore a
cooling process.

We may thus recapitulate the matter : the oxygen
inspired in the lungs is absorbed, and thence conveyed
by the arterial blood into the general system, and there
supports the slow combustion of the tissues, by which
combustion the animal heat is evolved ; the carbonic acid,
the ehoke-damp, the blood-poison, formed by this com-
bustion, is re-conveyed by the venous blood to the lungs,
and thence exhaled into the atmosphere.

If the mere absorption of oxygen be attended by the
evolution of a slight degree of heat, this is probably
counterbalanced by the simultaneous escape of carbonic
acid, the one losing, the other assuming, simultaneously,
the form of gas ; so that the resultant temperature may
be unchanged.

But the evolution of aqueous vapour must also be a
cooling process in proportion to the quantity of water
passing from the fluid state to that of vapour.

AND OTHER FORMS OF APNCEA. 53

The cooling effect of the inhalation of a cooler and
exhalation of a warmer portion of air constitutes then
an obviously cooling process.

And here I may revert to that marvellous law of the
animal economy, according to which the number and
extent of the respirations and the rapidity of the circula-
tion constantly maintain a due ratio to each other.
During repose, and especially during sleep, these are both
at a minimum ; during activity and effort of every kind,
they are augmented. In both cases the physiological
ratio or proportion between them is sustained.

A singular exception to this rule is observed in the
dog, which pants and projects its tongue, as the effect of
heat merely, I believe, without proportionally augmented
circulation ; the augmented respiration is merely a cooling
process.

If the due ratio between the circulation and the res-
piration were broken, one of two events must occur : if
the circulation be unduly and disproportionately aug-
mented, or the respiration be unduly suppressed, the quan-
tity of carbonic acid formed being unexhaled and there-
fore retained, the blood becomes poisoned and the patient
destroyed; if the respiration were unduly augmented,
the temperature of the animal would be lowered, and the
patient might die of refrigeration. The former fact ob-
tains in every case of apnoea ; it constitutes the death by
drowning, strangulation, " choke-damp." The latter
fact was actually produced in the splendid experiments of
Legallois, in which he used artificial respiration. Undue

5^ POSTUKAL RESPIRATION IN DROWNING

artificial respiration cools and destroys : the balance of
temperature is lost.

In treating the cases of apnoea and approaching as-
phyxia, these principles must be our guide : if we induce
too full and too frequent respiration even, the patient
will lose his temperature aud be destroyed.

I have already said and proved that a disproportionate
circulation is fatal, — that the tendency of the warm-bath
without respiration is deleterious.

If our attempts at artificial respiration be made in-
considerately,— if the induced respiration be too rapid or
too great, compared with the remaining degree of the
circulation, — we destroy our patient.

The warm-bath, or any other measure by which the
circulation may be sustained, respiration heing deficient,
is, I repeat, absolutely destructive. It cannot be re-
peated too often, that an animal dies of apnoea the more
promptly, the warmer the temperature, the more active
the circulation in a word, from whatever cause.

Our object in treating the drowned patient must be
two-fold : to restore the respiration, but to restore it in a
degree proportionate to the degree of the circulation ;
and to promote the circulation, in its turn, by any means
in our power, again augmenting the respiratory move-
ments as we may succeed in this second object.

These are precisely the two objects which I men-
tioned in the first part of this volume. It is since that
publication that I have ascertained the importance of
sustaining a just and due proportion between the two

AND OTHER FORMS 0¥ APNCEA. 00

functions, the circulation and the respiration, which it
must be our constant aim to promote simultaneously and
proportionately — either of these, without the other, being
actually fatal. Physiology must be our guide. Empi-
ricism has proved fruitless — nay, worse than fruitless;
it has not even taught us, that to raise the temperature,
without inducing effectual and proportionate respiration,
is, as I have stated, destructive.

With tlie postural respiration formerly described must
be combined tlie system of energetic frictions of the
limbs upwards, with firm pressure, by means of which
not only is the venous circulation best promoted, but tlie
warmth itself is best restored.

These things, too, are accomplished by the bystanders,
on the spot, without loss of time, therefore, without
apparatus of any kind, and even without medical aid.

Pocket-handkerchiefs should be used as towels,
Avhilst each looker-on may supply some garment — the
waistcoat, for instance — to lay under and over the patient,
the face, neck, and thorax being, however, if the weather
be not inclement, freely exposed to the breeze.

Nothing can be more admirable than the efficiency of
postural respiration. Requiring no apparatus, it has
solved the difficulty which formerly hung over our efforts
to save the half-drowned patient.

It has already saved many lives ; and it is destined
to save many, many more !

56 POSTURAL RESPIRATION IN DROWNING

§ III. — The Apncea of Still-born Infants.

The newly born infant and the new]y born of many
of the mammalia are in a peculiar condition, both in an
anatomical and physiological point of view.

The foramen ovale and the ductus arteriosus being
still open"^, the blood of the pulmonary circulation is
still diverted from the channels it is destined to pursue,
and in this respect it resembles the reptile tribes.

Respiration, and every stimulus, excejpt temjperature,
being absent, the excitability of the spinal system and the
irritability of the muscular system exist in the highest
condition, according to a law of animal life which I an-
nounced some years ago — viz. that these faculties are,
throughout the animal kingdom, inversely as the stimv.li.

The new-born foetus is therefore a creature of high
excitability and irritability. But such an animal bears
tlie absence of stimuli precisely in the same ratio. Res-
piration is the chief of these stimuli ; therefore — to ar-
rive at the subject of this section — the new-born foetus
can long survive the absence of respiration.

The condition of apnoea and asphyxia, without the

* This patent condition of the foramen ovale and ductus arteriosus
continues, according to the researches of M. Flourens, during eighteen
months of extra-uterine life in the human species. — Sistoire de la JDe^
couverte de la Circulation, pp. 67, 69.

AND OTHER FOUMS OP APNCEA. 57

absolute loss of life, is therefore of long duration, and
the hope of restoring the still-born infant is long pro-
tracted ; so must therefore our efforts at resuscitation be.
I must here briefly advert to the well-known question
of Harvey t, and the not less famous experiment of Buffon,
leaving them to my reader's meditation. Harvey asks
why the infant which has never breathed bears the sus-
pension of respiration longer than the infant which has
once respired ? J Buffon had the idea that if the foetus
of the class Mammalia was born under water, and res-
piration prevented, the foramen ovale and ductus arte-
riosus would be prevented from closing, and that in this
manner life might be protracted under water. A chimera !
For what respiration would there be, if both placental and
aerial respiration were excluded ? But life does not exist
without respiration.

Our efforts to restore the still-born infant consist —
1st. In measures to induce efficient respiration ; and
2ndly. In measures to maintain the circulation.
In order that respiration may be effected, we must
adopt the following means :

t Exercitatio Anatomica Secunda de Circulatione Sanguinis Gui-
lielmi Harveii, p. 258. 1751.

j " Cur foetus in utero non respirans aerem*, usque ad mensem
decimum, ob defectum respirationis non suffocatur } Cur natus in
septimo, vel octavo, quam primum aerem inspiraverit, inhibita post-
modum respiratione, ob defectum aeris suffocatur ?"

* Did the great Harvey overlook the placental respiration ?

0« POSrURAL RESMHATION IN DROWNING

1st. The infant must be placed in the joro;^^ position,
in order that all fluids, which might obstruct the entrance
into the windpipe, may flow away.

2ndly. Nature's mode of operation being to impress
the trifacial and cutaneous nerves, the external excitors
of respiration, by the external cold, we must dash a few
drops of cold water on the face and the general surface.

3rdly. We must proceed, having failed to excite res-
piration, to imitate the respiratory movements.

Tliis must not be done by ani/ forcing means ; even
the human breath, forced into the infant's lips, may tear
the deHcate tissue of the foetal lungs. We must, on the
contrary, adopt some measure of drawing the air into the
lungs. This is effectually accomplished by first placing
the little patient briskly in the prone position, to clear
the fauces ; then pressing gently on the back ; and then
removing that pressure, and turning it gently on the side
and a little beyond ; and so on, perseveringly.

4thly. Meantime, the limbs are to be rubbed, with
gentle pressure, upwards, to promote the circulation, by
propelling the venous blood towards the heart.

5thly. At proper intervals, we must again endeavour
to excite the respiration physiologically :

The infant is to be placed with the face prone, and
douched alternately and rapidly with water of the tem-
perature of 60° and 100° Fahr.

High and low temperatures are equally excitants of
the reflex function of respiration, and their power, within
physiological limits, is in proportion to the difference of
those temperatures.

AND OTHER FORMS OF APNCEA. 59

We must remember that the newly born infant is a
creature of high irritability and low stimulus, and that
the foramen ovale and ductus arteriosus are open — both
events greatly calculated to protract life and hope in the
case of apncea ; and we must long, very long, persevere
in our efforts to save the still-born.

The still-born infant has been restored after it has
been neglected for hours !

There is a remaining consideration. The etfect of
apncea is a condition of the blood surcharged with, and
poisoned by, carbonic acid : from tliis condition of the
blood, a secondary asphyxia and convulsions are apt to
occur in the adult.

The remedy/ and preventive of such secondary asphyxia
would be, free exposure to the breeze, with the inliala-
tion of very dilute pure ammonia.

The treatment of the still-born infant may finally be
thus briefly resumed in the form of Eules :

1st. Place the foetus on the face ;

2ndly. Sprinkle the general siirface briskly with cold
water ;

3rdly. Make gentle pressure on the back : remove
it, and turn the infant on the side ; and again place it
prone, with pressure ;

4thly. Rub the limbs, with gentle pressure, upward.^ ;

5thly. Repeat the sprinkling, only now with cold
and hot water (of the temperatures of 60° and 100° Fahr.)
alternately; or,

6thly. Plunge the infant into a hot and cold buth
alternatelv at 60° and 100° Fahr.;

60 fOSTURAL RESPIRATION IN DROWNING

7thly. Continue these measures, or renew them, from
time to time, even for hours. The embers of life may
not be entirely extinct —

" Lateat scintillula forsan."

§ lY. — On Trone and Postural Respiration.

The first important discovery made in the course of
this inquiry — and it is vitally important — is, that there
is no certain effectual artificial inspiration in the supine
position of the patient.

It may have appeared to succeed, and yet fail : for
on making pressure, a slight gurgling ^^piration is fre-
quently heard, without any subsequent inspiration, the
real vital process.

It is important to remember that whatever the mode
of artificial respiration adopted, in this position — whether
the direct application of the mouth, the syringe, the
bellows, pressure, &c. — it may and does fail; nay, that
it frequently does worse — driving fluids present in the
idiViCQs fatally into the windpipe.

The second is — that the very means which had failed
whilst the patient was retained in the supine position,
became perfectly available when the body was placed in
the PRONE position.

The rationale of this difference became evident when
the position of the tongue and condition of the fauces
in regard to fluids came to be observed and considered.

AND OTHER FOEMS OF APNCEA. 61

The third discovery — and this is also a vital one — is
that, in the prone position, rotation to the side, and a
little beyond, and rejoronation, are attended by i^^spiration
and ^.rpiration.

Lastly, it was found that gentle pressure along the
spine on pronation, and the removal of that pressure be-
fore rotation, induced augmented e.2'piration and aspira-
tion; so that, by combining these two manoeuvres, heau-
tiful life-giving Respiration is induced.

These results were clearly enough shown in my pam-
phlet presented to the Eoyal Humane Society. They
have been made still more manifest, and indeed actually
measured, by a little apparatus which I have devised for
the purpose, and which I have designated \k\RTnmmeter.
This apparatus is represented in this neat sketch, for
which I am indebted to Mr. Charles Hunter :

It consists of a long tube of caoutchouc, fitted to
another of larger diameter, made of oiled-silk. The
former being placed in one nostril, and the other nostril
and the mouth being duly secured by adhesive plasters,
the process of rotation and pronation, with alternate
pressure, is conunenced.

A Httle fluid being placed in the siphon, the com-
mencement and direction of the respiration is seen by
the movement of this fluid ; but sliortly it is not only
seen, but accurately measured by the graduated oiled-silk

62 POSTURAL RESPIRATION IN DROWNING

bag, which becomes more or less distended as air passes
into or out of it.

In the midst of these operations, it occasionally hap-
pens that a little fluid passes into the tube, with inter-
ruption to the free i/^spiration or ^.rpiration. This is at
once made manifest by the condition of the siphon.

The Pnmometer not only detects and measures the
degree of the Postural Respiration, but demonstrates the
comparative worthlessness of supine- and the extreme value
^A prone- respiration. The very obstructions to respira-
tion in the former position, find their efi*ectual and appro-
priate remedy in the latter.

The experiments, which were very numerous, were
made at St. George's Hospital, by Mr. Edward Long
Fox, Mr. Charles Hunter, Mr. R, L. Bowles, and other
gentlemen ; the first being made by Mr. Pox.

The results were always the same : dubious or null
in the supine position ; admirable and never failing in
the PRONE position.

When they were concluded, I proposed to Mr.
Hunter and Mr. Bowles to repeat them ; and I subjoin
the report drawn up by Mr. Bowles :

'' Dear Dr. Marshall Hall, — The enclosed experi-
ments, to each of which I have appended a few remarks,
were made by Mr. Hunter and myself, the object being
to confirm or correct those previously made for you by
Mr. Fox and ourselves, feeling that, from our former ex-
perience, we could now guard against several fallacies
likely to arise during the experiments. The mode of
procedure was the following :

AND OTHER FOEMS OF APNCEA. 63

" An India-rubber tube was inserted into one nostril,
the opposite one, with the mouth, being closed, and ren-
dered air-tight by plasters, bandages, &c. ; the free end
of the tube was now attached to a glass siphon, contain-
ing a small quantity of water in its bend, and to the op-
posite end or this siphon was fastened an oiled-silk bag,
made in the form of an intestine, to which it was similar
in appearance and cahbre, when inflated. This bag,
when full, contained forty cubic inches. The water in
the siphon acted as an index of the direction of the air
in its passage to or from the bag, or, as we have called
it in the experiments, the oiled-silk tube ; it was the
amount of air expired into this tube on pronation, &c.
which enabled us to compare it with the natural expira-
tion of thirty inches ; for when the tube was half filled,
which was easily proved by pressing the air towards its
closed extremity, we inferred that we had twenty cubic
inches in the tube, and so on. We did not pretend to
perfect accuracy as to the amount, but it must be an ex-
ceedingly near approximation to the truth.

" I think you will also see, in these experiments, proof
that, though the supine position does not in every case
prevent the passage of air, it does so in a large proportion
of cases ; and if it do so in one case only, that appears
to me quite reason enough why that position should be
avoided.

" Believe me faithfully yours,

" R. Leamon Bowles.'"'

" Eaton Place South, Eaton Square, 1856."

64 POSTURAL EESPIRATION IN DROWNING

" SUBJECT I.

" A male subject, much emaciated, about fifty years
of age, and six feet in height ; the body was not quite
cold, and cadaveric rigidity had but partially come on ;
he had been dead ten hours. The apex of the tongue
reached the incisors, and the body of the tongue was at
the floor of the mouth, so that a considerable space ex-
isted between its surface and the roof of the mouth.
Some fluid was seen at the back of the fauces, and, on
laying the body on its face, a large quantity of fluids and
solids from the stomach made their escape.

" Eccp. \.' — Semi-rotation, prone and lateral. In
the former position, the tube was half filled ; and in the
latter, it was instantly emptied.

" Ex]). 2. — By alternate pressure and relaxation on
the thorax (the subject supine) j the same result was ob-
tained as in Exp. 1.

" Exp. 3. — Semi-rotation, prone and lateral, was
again had recourse to, and with the same result as before.

" Exp. 4. — Alternate pressure and relaxation on the
thorax in the supine position. This time, not the slightest
inspiration or expiration could he oltained,

" On removing the coverings of the mouth, the
tongue was seen to be in the same position as when we
commenced; but there was again fluid in the pharynx.

" Remarks. — This case demonstrates how, in the
supine position, fluids in the stomach might interfere
with respiration ; for, in Exp. 2, a good result was ob-
tained, no fluid being in the pharynx ; but after the fur-

AND OTHER FORMS OF APNCEA. 65

tber movements of Exp. 3, more fluid, &c. had been
ejected from the stomach, filling up the pharynx, and
totally preventing the passage of air into or out of the
trachea. This case also shows that the epiglottis does
not in all cases cover the glottis in the supine position.

" SUBJECT II.

" A middle-aged man, very much emaciated, having
suffered for a long time from abscess of the brain ; rigor
mortis still present; the brain had been removed.

'^ Exp. 1. — Alternate pressure and relaxation on the
thorax, the body supine : no effect.

" Exp. 2. — On pronation, about one third of the tube
— on applying pressure, nearly the whole tube — was
filled ; on removing the pressure, the tube was emptied
to one third ; and on resuming the lateral position, it was
quite emptied. These movements were several times
repeated, and invariably with the like series of results.

" Exp. 3. — Exp. 1 was repeated. No effect was at
first produced ; but on pressure being applied by a sud-
den jerky some obstacle seemed to be removed, and ex-
piration was the result, to such a degree that the tube
was nearly filled, as in Exp. 2 ; and on removing the
pressure, the corresponding amount was inspired. After
this, alternate pressure and relaxation, in the supine po-
sition, produced inspiration and expiration with ease.
On removing the tube, no obstacle was to be seen in the
pharynx.

. " Remarks. — Exp. 1 proves that in the supine posi-

6Q POSTURAL RESPIRATION IN DROWNING

tion something does at times prevent respiration in the
dead subject ; and although^ in Exp. 3, respiration was
produced in this position, it could not be done at the
commencement ; some obstacle had first to be overcome,
probably adhesion of the epiglottis to the back of the
pharynx by viscid mucus, as the following observation
would tend to prove :

"■ On cutting down and removing the right side of
the pharynx, with the corresponding halves of the hyoid
bone and thyroid cartilage, in another subject, a tolerable
view of the position of the parts w^as obtained. The
epiglottis was in direct apposition, by its laryngeal sur-
face, w^ith the posterior wall of the pharynx, so as to pre-
clude the possibility of the passage of air. When, how-
ever, the head was allowed to hang backwards over the
edge of the table, the bending of the cervical vertebrae
caused the posterior wall of the pharynx to recede from
the epiglottis, so as to allow the free passage of air. If
the tongue had been drawn forwards, would the epiglottis
have been removed from the pharynx? or would the
prone position cause it to fall forwards ?

" SUBJECT III.

" A middle-aged man, very short and emaciated;
had suffered from extravasation of urine. There w^as
some dulness on percussion on the left side of the chest ;
rigor mortis present ; tongue very stiff and moved about
with difficulty. Whilst the body was being shifted, we
could distinctly hear the rushing in and out of the air.

AND OTHER FORMS OF APNCEA. 67

" Exp. 1. — Free expiration, filling more than half
the tube, from pressure in the supine position.

" Exp. 2. — The arms were folded beneath the fore-
head, and fastened there by bandage. On pronating the
body, nearly one third the tube was filled, and on apply-
ing pressure, a little more than one third.

" Exp. 3. — As a considerable portion of the chest
was, by the arms being folded beneath the head, raised
from the table, a block was so placed that, on pronation,
the thorax should rest upon it. No better result, how-
ever, followed this than in Exp. 2, except that by pres-
sure the tube was now nearly half filled. On resuming
the lateral position, the tube was emptied as usual.

" Exp. 4. — The head was allowed to hang over the
edge of the table, as in all pre\aous experiments : and
now the tube was more than half filled, as in Exp. 1, on
pronation with the addition of a little pressure.

" Exp. 5. — Pressure in the supine position produced
the same result as in Exp. 1. On removing the tube,
the fauces were quite clear, and free from fluid.

" SUBJECT IV.

" A middle-aged man; had suffered some time from
a purulent discharge from the side of the chest, with
which cavity the opening was supposed to communicate ;
and there was considerable dulness on percussion over
the same side of the chest. Eigor mortis less marked
than usual ; the tongue had dropped back into the pha-

68 POSTURAL RESPIEATION I.N' DROWNING

rynx ; but it could not be accurately ascertained whether
it quite stopped the way or not ; but

" Exp. 1. — Pressure on the thorax, the body supine,
produced no result whatever,

" Exp. 2. — ^Proni-lateral movements, with the head
on the table : a little more than one third the tube was
filled ; increased by pressure to nearly one half.

" Exp. 3. — Proni-lateral movements, with head hang-
ing over the edge of the table : nearly half the tube full,
which took place very readily at first, but afterwards more
slowly ; on taking out the tube, gritmous fluid from the
stomach was found in it. After this was emptied out,
the experiment was repeated, and the air now passed in
and out as easily as at the first, so that the tube was
nearly filled.

" Exp. 4. — Pressure on the thorax, the body supine :
no result, after repeated trials. It being observed that
the abdomen was very lax, so interfering with the
amount expired, from allowing the diaphragm to descend,
a binder was applied ; but a large quantity of the same
fluid as before was ejected from the stomach into the
tube. The subject was pronated, and the fluid allowed
to run out from the tube and pharynx.

" Exp. 5. — The arms were folded beneath the chest,
and the proni-lateral movements employed ; but with
very little result ; the effect of the disease of the chest ?

" Exp. 6. — Pressure in supine position ; no result.
On removing the tube, the body of the tongue was far
back in the fauces ; but no fluid could be seen.

AND OTHER FORMS OF APXCEA. 69

'' Remarks, — It was difficult to say whether it was
the tongue or fluid in the pharynx that prevented the
passage of air when the subject was supine ; but the
tongue was much more moveable than in previous cases,
and therefore farther back. It was evident, in Exp. 3,
that the fluid was the cause of the difficulty.^^

These experiments require and merit special study.

On writing to Mr. Pox, and proposing again to
repeat our experiments, this gentleman observed —

" I cannot see that any thing in point of evidence
would be gained by repeating the pronation and rotation
experiments. They were conclusive to the minds of all
of us who witnessed them.

" On referring to my notes of the experiments at
which I assisted, I find that expiration was immediately
produced by pronation of the body, except on one or two
occasions, in which the tube became filled with the fluid
from the stomach, or the trachea was full of grumous
fluid after much disease of the lungs. So that I should
say, it was invariably successful, with the glottis and the
mouth free."

Since this period, the efficiency of rotation and pro-
nation, in inducing respiration, has been confirmed by
many observers, amongst whom I may mention Mr. Paget
and Dr. Snow.

Prom aU the evidence I draw the following con-
clusions :

1. In the majority of cases, it was impossible, by

70 POSTURA.L RESPIRATION IN DROWNINO

applying and removing pressure to and from the sternum
and ribsj to induce effectual ^.rpiration and w?spiration,
the body being in the supine position ;

2. In some cases, the application of the pressure in
this position induces a little gurgling expiration, no in-
spiration occurring on its removal ;

3. In one case, in wliich it seemed impossible to
induce expiration by making pressure, inspiration became
possible after applying pressure with some degree of vio-
lence, some obstacle being removed ; was it the tongue
which had fallen backwards, and had been replaced by
the impulse of the expired air ?

4. In another case, the epiglottis was found, on
examination, pressing against the posterior part of the
pharynx, so as to obstruct the entrance into the wind-
pipe;

5. In nu7nero2is cases, fluids, either present in the
mouth, or regurgitated from the stomach, were found to
obstruct the entrance into the air-passages ;

6. We can therefore never be confident of being
able to induce respiration in ani/ but the prone position,
or position approaching the prone, hi/ any means !

7. Nay, one cannot be assured that, in attempting
to induce inspiration in the supine position, we do not
force foreign matters into the trachea, and so destroy the

8. The same danger attends all other positions,
however slightly inclined towards the supine;

9. In the prone position, the means recently pro-

AND OTHEU FORMS OF APNCEA. 71

posed to accomplish respiration — viz. alternate pronation
vnih dorsal pressure, and the reraoval of that pressure,
and rotation — hate never failed, although our expe-
riments have been almost innumerable ;

10. It is plain that in \ki{t prone position the tongue
tends to fall forwards, and aU fluids flow from the pha-
rynx and mouth, leaving the entrance into the larynx

FREE ;

11. It is demonstrated, by our experiments, that
when the subject is laid prone, the counter-pressure on
the thorax and abdomen induces expiration, the degree
of which is augmented by dorsal pressure, and that these
phenomena are reversed on removing that pressure and
on rotation ;

12. Such manoeuvres are equivalent to Respiration,
and respiration is the remedy for Apncca : the conclusion
is obvious.

13. All this can be said of no other mode of pro-
ceeding hitherto devised ;

14. In the present state of our knowledge, then,
alternate pronation and rotation, and pressure, as just
explained, are the remedy for Apnoea.

15. But these measures must be administered on
the instant, on the spot, in the free air ;

16. All delays — and all other measures hitherto
discovered and applied are delays : removal, the warm
bath, galvanism — are homicidal! — a verdict which no
authority, nothing short of such indubitable experiment,
made by competent persons, as has not yet been made,
can gainsay.

72 POSTURAL RESPIRATION IN DROWNING

17. Continued cold^ within pliysiological limits,
prolongs life in the circumstances of apncea ; continued
warmth shortens it, and is therefore opposed to recovery,
notwithstanding the place it has so long held amongst
the rules for rescuing the drowmed, &c.

18. Sudden cold and sudden heat, and especially
the two alternately, are, on the contrarj^, excitants ofre-
sjnration, and therefore remedies in the early stage of
apnma.

19. In general, nothing can be of more fatal ten-
dency than the time lost in removal — the warm bath —
galvanism ;

20. I know of nothing in medicine so near demon-
stration as the proofs of the dangers of the former system,
and of the simplicity, the safety, and the efficacy of the
Eupncea of postural respiration.

§ V. — On the Inhalation of dilute pure Ammonia in
Ajmoea.

I have great reason to believe that there is much
promise of good from the inhalation of dilute pure am-
monia in apnoea. I detail two experiments very suc-
cinctly :

I placed 0 le mouse in five ounces of atmospheric air :
it died m forty minutes.

I placed a second mouse in the same quantity of
atmospheric air, into which pure ammoniacal gas was
diffused : it survived ninety minutes !

AND OTHEE FOEMS OF APNCEA. 73

The difference between these two experiments is that
of carbonic-acid blood-poison, retained unchanged, and
exhaled or neutrahzed.

Since these experiments, part of a series, were made,
Dr, J. W. Ogle and Mr. Lloyd Bullock have kindly re-
peated them, and have arrived at the same conclusions :
the addition of. dilute pure ammonia prolongs life in an
animal confined in a limited portion of atmospheric air.
It is therefore an antidote to the carbonic-acid blood-
poison in apncea. Being inhaled, it not only neutralizes
the carbonic acid in the air-cells of the lungs, but, being
also absorbed, it doubtless neutralizes that other portion
of this poison still circulating in the blood, and, through
it, in all the organs.

What a beautiful subject for new experiment !

But a special use for the dilute vapour of pure am-
monia presents itself in the case in which we have to
contend with the vapour of burning charcoal and other
forms of carbonic acid.

Those who descend into such a vapour in wells, the
coal-pit, the brewing- vat, for whatever purpose, should
wear a mask, exhaling the vapour of dilute pure ammo-
nia. Those who have breathed an atmosphere surcharged
by carbonic acid, should be succoured by the same agent.
The state of the atmosphere too crowded by people, or
too much imbued by the results of the combustion of gas,
should be corrected by the same means, attention being
paid to due ventilation.

The inhalation of dilute pure ammonia is the special
preventive of secondary apnoea.

74 POSTUEAL RESPIRATION IN DROWNING

§ YI. — Of the Inhalation of Oxygen,

Is oxygen really a remedy in apnoea ? Is it as effi-
cacious as atmospheric air? Is oxygen more rapidly
absorbed in slow combustion from pure oxygen than
from atmospheric air ? This too presents a subject, not
for hasty conclusions, but for careful experiment.

§ VII. — The Rationale of the fatal Tendency of the
Warm Bath in Apnoea.

There is a physiological relation between the circu-
lation and the respiration, any deviation from which, in
either direction, is of a fatal tendency.

During the systemic (not the pulmonic) circulation,
carbonic acid is formed ; in respiration, the oxygen
necessary for the formation of this carbonic acid is
supplied, and the carbonic acid so formed is evolved
from the system.

The immediate baneful effects of the suspension of
respiration arise from the privation of oxygen, and from
the retention of the carbonic acid previously formed,
which becomes the blood-poison.

An animal placed in perfectly pure nitrogen or
hydrogen gas dies in violent convulsions instantly. And
this is doubtless owing to the privation of oxygen ; for

AND OTHER FOUMS OF APNCEA. 7^

carbonic acid might be exhaled into nitrogen or hydro-
gen gas.

But an animal dies also in air consisting of such
proportion of carhonic acid with oxygen as to prevent
the evolution of carbonic acid from the blood, although
the quantity of oxygen might be so great that a taper
blown out, and burning only as a s^Ktrh, would be
instantly re-kindled into flame.

If, without producing effects so, sudden as those
described, we change the relative proportion of the
respiration and the circulation, morbid phenomena are
produced special to each case. If the circulation be
disproportionately augmented, carbonic acid is formed,
and being morbidly retained, shghter convulsion and
slower death ensue. If the respiration is unduly and
disproportionately augmented, the animal is cooled: for
mere pulmonary respiration is a cooling process, by the
difference of temperature of the i?z spired and expired
air ; and in this case also the animal dies, but now from
loss of temperature.

This latter is the case in the patient affected by
apnoea, if the respiratory movements be unduly hastened —
that is, disproportionately to the rapidity of the remaining
circulation.

On the other hand, if, in apnoea, we excite the
circulation without simultaneously and proportionately
inducing respiratory movements, we destroy our patient
by carbonic acid, formed in the course of that circulation,
and uneliminated by respiration.

E %

76

POSTURAL RESPIRATION IN DROWNING

This statement leads me to the proper subject of
this paper — the Rationale of the Injurious and Tatal
Tendency of the Warm Bath in Asphyxia: for it is
injurious, and has, I am profoundly convinced, of itself
proved fatal in cases in which the patient, without it,
would have spontaneously recovered. Such a case in-
deed did occur recently at Boulogne.

In such a case, it is surely not less essential to the
progress of science and our art to remove error than to
establish truth.

Warmth is so obviously a stimulus, and a stimulus
is so apparently required for a patient taken out of the
cold water in a state of apnoea, that in recommending
the warm bath we seem to be addressing ourselves to
the common sense of mankind, and it was a step in
advance to enteratin a dotibt on the subject.

But when we begin to experiment — when we learn
that an animal deprived of respiration by being sub-
merged under water, lives longer in cool water than
in warm water, we learn to consider whether, in fact,
coolness is not more favourable to life in the apnoea
from submersion, than warmth. We recall to mind, too,
that animals bear the abstraction of respiration in pro-
portion to their coolness : the hibernant animals and
the batrachian tribes will scarcely drown at aU. If
a kitten be first cooled, or if it be immersed in cool
water, it will not drown so soon as it would do if
submerged at its ordinary temperature in water of the
same temperature — facts established by Edwards, by

AND OTHER FORMS OF APNCEA. 77

M. Brown-Sequard, and myself, and witnessed by the
secretary of the Eoyal Humane Society, and by its
superintendent in Hyde-park.

Thus experiment is made to correct preconceived
ideas, however apparently consonant with common sense.

There are other facts which point to other modes of
treatment of the drowned, which the admioistration of
the warm bath necessarily excludes. If a poor creature
be perishing for want qI foody we cautiously administer
footh If a man be, in like manner, perishing for want
of air, should we not administer air ? Is not this simple
and reasonable ? And in the case of drowning, is not
the want of air the first condition to which we should
bring succour, and the want of temperature the second
or third ? And should we not first administer to the
first want ? Then, in the case of drowning, we should
administer air first, and warmth in the second place. But
may not the warmth administered without air, do great
and absolute injury ? It raises the temperature, and in
so doing augments the necessity of respiration to life.

In the fir8t place, if any effect be produced by the
warm-bath, the circulation is accelerated. But to accele-
rate the circulation without inducing, at the same time,
efficient respiration^ is to augment the formation of
carbonic acid — the llood-poisoUf — without its elimi-
nation from the system, and it induces, consequently,
a fatal result;

Secondly, all excited respiration through the medium
of the cutaneous excitor nerves is excluded, the uniform

78 POSTURAL RESPIRATION IN DROWNING

temperature of the warm bath excluding the excitants
of those nerves arising from the alternate application of
heat and cold to the surface ;

And thirdly, imitated respiration is excluded by the
very sustained position of the patient, excluding, as it
does, alternate pronation and rotation, and pressure
applied and removed — those changes of position and com-
pression which induce respiratory movements.

So that the warm bath is not only positively
injurious by poisoning, but negatively, by excluding
the de-poisoning process.

Lastly, the warm bath excludes those frictions of
the limbs upwards, with pressure, which really consti-
tute the most effectual means of promoting the circu-
lation and warmth.

Nor is it unimportant to save the time expended in
preparing the warm bath, or in carrying the patient to it.

And it is scarcely a minor point to direct all our
thoughts and energies, undiverted, to the important
remedies exclusively.

In conclusion, the warm bath is of doubly fatal
tendency: it is so in itself positively; and it is so
negatively, by excluding every real remedy.

All have heard of the Grotto del Cane, The poor
dog is put into carbonic acid, and taken out affected by
apnoea. It is plunged — not into a warm lath — but into
the shallow water of the adjoining lago Agnano, and taken
out — restored !

I cannot conclude this section better than by ad-

AND OTHER FORMS OF APXCEA. 79

ducing the penultimate paragraph of Edward's ad-
mirable work :

"We have seen," says this profound physiologist,
" how fatal heat is in asphyxia (apnoea), or in cases of
restricted respiration." " If the application of heat be
continuous, it will prove fatal. In some cases it may be
useful, if it be of short duration : when an animal is
plunged into water at 104° Tahr. its movements are
much more energetic, but less numerous, than at inferior
temperatures. There are circumstances in which a
momentary application of heat may be employed to
^excite movements of the thorax. The immersion of a
great part of the body in hot water is frequently an
efficacious means for animating the still-born infant. But
as soon as such movements are produced, or if they do
not occur, we must renounce a mode of proceeding of
which the prolonged use would be fatal !""^

§ YIII. — The Banger of all Attempts at Artificial
Respirationf except in the Prone Position.

I have shown, in the last section, not the inutility
only, but the danger of the loarm bath in the treatment
of apnoea or asphyxia. I now proceed to demonstrate
the danger of all attempts at the induction of artificial

* Des Agens Physiques, p. o29-o30.

80 POSTURAL RESPIRATION IN DROWNING

respiration — the special remedy against apnoea, — except
in the prone position.

If the patient, in apnoea, be moved and placed in
the supine position, in which no attempts at artificial
respiration can be effectually made, what is the condition
of the rima glottidis or entrance into the windpipe ? Is
it free, so that air may be pressed or drawn into it ?
And if apparently free, does it remain so at the moment
when an effort to force or draw air into it is made ?

1. Is the tongue so securely situated, all muscular
energy having ceased, as neither io fall backwards, nor
to be drawn backwards, and so close or obstruct the
orifice and entrance into the windpipe ?

2. Is there no accumulation of mucus, or other
animal fluids, or of fluids from regurgitation from the
stomach, which may also obstruct the glottis ? nay, more,
which may be forced or drawn into the windpipe,
inducing a second and fatal suffocation ?

No one can say, a priori, that one, or even both, of
these events may not occur. These are not only possible,
but probable, — not onl)/ probable, but inevitable under
certain circumstances.

There is one fact of the utmost importance. When,
from any circumstances, the nervous and muscular powers
are in abeyance, nothing is so common as regurgitation
from the stomach, from change of position, compression,
&c. Under such circumstances, compression of the sides
of the thorax would certainly be apt to produce this
effect. Now, in the supine position, the matters so

AND OTHER FORMS OP APNOEA. 81

regurgitated would remain in the fauces, obstruct the
glottis, or, when the pressure was removed, be drawn
into the windpipe ! Leroy's mode of attempting to effect
artificial respiration, of which a sketch is given by the
Royal Humane Society in its Reports, is utterly ineffectual;
but if effectual, would be replete with danger. The only
certain safeguard against such a fatal accident is — the
PRONE position. In this position, the tongue tends to fall
forwards, and all fluids flow from the fauces and the
mouth, or are expelled by the first induced expiration.

All this is reasonable, a priori. But we must not
rest here. Our appeal must be to factSj not to mere
notions. The facts must be ascertained by careful
examination of the dead subject.

1. What is the position of the tongue when the
body has been roughly moved about and laid in the
supine position, all cadaveric rigidity of the parts being
overcome by previous movement of this organ backwards
and forwards ?

2. What is the further position of the tongue in the
supine position, at the moment of attempted inspiration,
first, by means of the bellows, or, secondly, by the removal
of the pressure on the ribs or sternum, and the consequent
dilatation of the thorax ?

These facts may be ascertained by removing the
tissues on one side of the neck, so as to give a lateral
view of the tongue, glottis, epiglottis, and pharynx, and
by replacing those tissues by a portion of transparent
glass of the proper size and form, properly placed and
carefully maintained in its position.

82 POSTURA.L RESPIRATION IN DROWNING

The first part of tliis examination has been abeady
made : — The subject being placed in the supine position,
and the lateral parts of the neck being removed, so as to
admit of observing the relative position of the internal
organs — the tongue, the epiglottis, the glottis, the
pharynx, — it was seen that obstruction to the entrance
of air actually did take place.

I now propose to place a piece of transparent glass
so as accurately to close the cavity and allow of the
observation, first, of the effect oi position, the supine and
the prone comparatively, and then of any attempt to
induce inspiration,

A similar examination of this internal cavity in
reference to fluids present in it — and we never can know
when such fluids are present — is unnecessary : fluids will,
in the supine position, gravitate to the lowest parts of
a cavity, and will be drawn into an open orifice, such as
the glottis, under the influence of air forced or inhaled
into it. And such an event not only renders all attempts
at i^^spiration nugatory, but induces a permanent, because
material, obstruction of the entrance in the windpipe.

In confirmation of these views, I revert to experi-
mental y«<?^5 already given.

'^ The following experiment has been repeated many
times, and has been witnessed by George Webster, jun.
Esq. of Peckham, Mr. Williams, superintendent of the
Royal Humane Society, Hyde-park; and other gentle-
men :

The dead subject being placed in the supine position,
and pressure made on the sternum and ribs, a little

AND OTHER FORMS OF APNCEA. 83

gurgling was heard in the throat; but, the pressure
being removed, there was no evidence of i^^spiration."

Now let us contrast with these abortive attempts to
induce artificial i//spiration in the supine position, the
beautiful and life-giving results — f/zspiration and ^.rpira-
tion — of alternate rotation from the prone position and
repronation. I continue the quotation :

"The subject being then turned into the prone
position, and pressure being made on the spine and the
ribs, and removed as before, there were free e:rpiration
and zMspiration."

Far more marked is the effect of pronation and
rotation :

" The subject was turned into the prone position :
considerable expiration took place, w^hich was much
augmented by pressure of the hands on the back. On
removing this pressure, a little inspiration took place.
The body being then rotated on the right side, consider-
able inspiration again took place, whilst moving through
one fourth of a circle; on continuing the rotation,
inspiration continued until the shoulder was half-way
between the lateral position and the table, when it
ceased.'"

I conclude the momentous subject by several
aphorisms in regard to the treatment of apncea : —

1. The effects of suspended respiration can only be
removed by the renewal of respiration.

2. Artificial respiration can only be certainly,
effectually, and safely performed in the prone position ;

84? POSTUHAL EESPIRATION IN DROWNING

3. In the supi7ie position the larynx is apt to be
obstructed by the falling back of the tongue and
epiglottis, or by the accumulation of fluids already in the
pharynx or regurgitated from the stomach.

4. These fluids may be fatally inhaled into the
windpipe when aspiration is mechanically effected.

5. All other measures are subsidiary, even the
rubbing the limbs with pressure upwards ; and all which
exclude respiration are, ipso facto, destructive; the warm
hath is of douhly fatal tendency, — first, by excluding
pronation and rotation, and secondly, by promoting the
formation and the circulation of the blood-poison —
carbonic acid.

§ IX. — 0)1 the Prognosis in Apncea.

The prognosis in apnoea (or asphyxia) depends upon
three elements :

First, the physiological constitution of the patient ;

Secondly, the stage of the apnoea (or asphyxia) ;

Thirdly, the promptitude with which the chief reme-
dies, respiration, or pronation and rotation, are adminis-
tered.

The physiological constitution of the new-born infant
is that of low stimulus and of high irritability. The re-
spiration is, in fact, the respiration, so to speak, of the
fish tribes — the placenta representing the branchiae ; and

AND OTHER FORMS OF APNffiA. 85

even of the lowest of these, the extent of surface of the
placenta, compared with the magnitude of the animal,
being considered.

But the duration of life in apnoea is in the inverse
proportion of the quantity of respiration ; that is, the
less the degree of respiration, the longer its suppression
can be sustained without the extinction of life. The
same hibernant animal lives a longer or a shorter time
submerged under water, just according to the degree of
hibernation, with its low respiration, in which it may be
placed, and dies more promptly as that hibernation is
exchanged for activity with its high respiration.

The degree of respiration is always linked with pro-
portionate circulation — as effect is linked with its cause —
or as supply is linked with demand. The quicker the
circulation, the quicker the formation and elimination of
carbonic acid, or the ^(^(?6>r/-poison, but the ordinary excitant
of respiration, the degree of necessity for its elimination,
being in the same proportion. Hence the destructive
tendency of the warm hath, in the ordinary sense of
this phrase ; for I do not now speak of the sudden and
momentary hot lath (which may prove an excitant of
respiration), but of the ordinary continued warm bath,
which, if it accomplish any thing, augments the circula-
tion, respiration being still in abeyance ; with this aug-
mented circulation, there is augmented formation of the
blood-poison, carbonic acid; and this being retained,
proves a *' choke-damp," and, in a word, destroys hfe.
Now the warm-bath at the Royal Societ/s receiving-

86 POSTURAL EESPIRATION IN DROWNING

house lias been a warm bath, and has usually been con-
iinued during twenty minutes.

But to return to the practical object of this section,
which will be found, as ever, to coincide with ^/^eory — (so
commonly and ignorantly decried), — the new-born infant
is a creature of the lowest degree of respiration. Its life,
and the hope of its restoration in apnoea, is — the longest,
I believe that, in almost every case of the apncea of the
still-born, the success of the postural respiration will be
complete. For the same reason, the application of this
method should be the most persevering .

In regard to the stages of apnoea (or asphyxia), I
may observe that there are most distinctly /bwr ;

The first is that in wliich the breathing is not quite
extinct ;

Tlie second, that in which the respiration has ceased,
but may be excited by those means which I have so dis-
tinctly pointed out on various occasions;

The third, that in which respiration has not only
ceased, but is in-excitable, and in which therefore our
liope of resuscitation is in imitating or inducing the re-
spiratory movements — that is, in pronation and serai-
rotation ;

^\\Q fourth and last stage is that of true asphyxia —
that in which not only all respiration, but all pulsation
has ceased, and with it almost all hope. Sir B. C.
Brodie says, emphatically — " If that action of the heart
hy which the circulation is maintained should cease, it
can never he restored. This I positively assert, after

AND OTHER FORMS OP APNCEA. 87

made it the subject of a very careful hivestiga-

In the cases of the drowned or the strangulated, the
patient may come under our notice in any one of these
stages, or in any prior, posterior, or intermediate con-
dition.

The course of tJiis apnoea or asphyxia is extremely
short : four or five minutes of complete submersion is
supposed to be hopelessly fatal. In a given case, the
hope is precisely commensurate with the promjptitude with
which this treatment is appKed. Certainly the plan or
rules recently proposed to the Eoyal Humane Society
to be adopted before postural respiration — that is, the
time lost — would extinguish all chance, all hope, and
therefore all fair and honest trial of that method ; and I
trust that Society will, for its own honour and credit,
reject all such insidious proposals.

The moment we see the drowned patient, we should
observe, for a moment, whether there be respiration, and
if so, vmit and still <9^5^;t^ carefully ; if breathing con-
tinue, be careful of interfering ; and, constantly watcliing,
direct the wet garments to be removed, and the limbs to
be rubbed, dried and clothed as promptly as possible,
every one contributing some article of clothing.

But if the breathing has ceased, if there be real
apnoea, then, without any delay of any kind, we should
enforce at once the best measures ; and those are already

* Lectures on Pathology and Surgery; 1846; p. 81.

88 POSTURAL RESPIRATION IN DROWNING

demonstrated to be those already described, unpost-
poned.

I regard the new Eules lately proposed to the Humane
Society as unfair towards the new method, and as fatal to
the patient. I believe it to be absolutely impossible that
any asphyxiated patient should so survive i\ie preliminary
measures proposed in those Eules, as to be subsequently
recovered, or recoverable, by that method, or ani/ method.

The prognosis in cases of drowning, &c. is made up
then of three elements : 1. the constitution of the pa-
tient; 2. the stage of the affection; 3. i]\Q promptitude
of the treatment ; to which, of course, must be added the
adequacy of the remedies.

In concluding, I wish briefly, but distinctly, to restate
the chief practical points embraced in those remedies :

1. It is obvious to all unsophisticated persons that
the effects of

Suspended RespiratioUj
by whatever cause, are only to be removed by the
Restoration of Respiration.

2. It is proved by experiment on the dead subject
that respiration is effected by the

Pronation, and

Rotation of the body, with pressure duly applied and
removed.

3. The special remedy for apnoea, then, is this

Postural Respiration.

AND OTHER FORMS OF APXCEA. 0^

§ X. — 0?i Narcotic Poisoning.

Many years ago, a lady drove to my door (in Man-
ehester Square) from Avenue Road, in the utmost con-
sternation, having shortly before swallowed an ounce and
a half of Battle/s solution of opium, in mistake for a
senna draught.

I instantly applied the stomach pump with my own
hands, and her life was saved !

I have often asked myself the question — What should
I have done, had I not had the stomach pump in all
readiness, and had I not been able to induce vomiting ?
Until this hour, I knew not how satisfactorily to answer
this fearful question.

There are two stages in narcotic poisoning, in each
of which postural movements are, in the absence of the
stomach pump, our /lope.

The first is that in which our object is to remove the
poison from the stomach by the induction of mechanical
vomiting, but in which, from the degree of narcotism, all
physiological remedies fail.

The second, that in which our object and hope are,
to continue respiration until the elimination of the poison
from the system may be accomplished.

In the former case, the patient should be laid on a
table, with the head projecting beyond its edge, if pos-
sible ; and, being placed on the side, the finger of one
person is to be introduced into the faucesj whilst the

90 POSTURAL RESPIEATION IN DROWNING

body is briskly and repeatedly rolled into the prone posi-
tion, and pressure or a smart blow on the back applied
by another.

If there be the slightest degree {^^ scintilkdd^) of ex-
cito-motor power remaining, the cardia, already some-
what relaxed from torpor, will be still further relaxed,
physiologically, whilst the glottis^ the safety valve of the
trachea, is closed, and the tliorax and abdomen being
compressed by a force equal to the superincumbent weight
of the body, to which further force may be added by
means of pressure made along the spine, mechanical
vomiting will be produced, and the poison expelled.

This desirable effect will be produced in cases in
which the narcotic torpor is too great to admit of excit-
ing the very complex act oi phi/siological vomiting.

But now let us suppose that the narcotism is too
deep for the success of this manoeuvre, — that the second
case is before us. Then our hope consists in continuing
respiratory movements until the poison is eliminated from
the blood and the general system. In one word, our
hope is in prone and postural respiration, such as I
have recommended it for apnoea.

I suppose that volition has ceased, and that the pa-
tient can no longer be made to move or walk about ; that
all good physiological respiration has ceased, or is about
to cease; then — then one hope still remains — postural
respiration — and the other measures comprised in the
treatment of apnoea; and I need not say how long and
perseveringly this method should be continued.

AND OTHER FORMS OF APNOEA. 91

§ XI. — The Laryngismus of Chronic Laryngitis,

Chronic laryngitis is liable to extreme and dangerous
spasmodic exacerbations, assuming the form of laryngis-
mus.

In a very early volume of the Medico -Chirurgical
Transactions, I pubHshed a case of Chronic Lar}Tigitis
in which tracheotomy was instituted to protect the patient
from the immediate danger from these paroxysms of
laryngismus, whilst mercury was freely administered as
the cure of the laryngitis.

Such is always the place occupied by tracheotomy.
It is itself a cure for no disease.

It is in such a paroxysm as I have described that
postural respiration might save the patient, if most time-
ously applied. And unless tracheotomy be instituted,
due warning of the imminent danger of these paroxysms,
and of the remedy, should be given to the friends of the
patient.

I see this subject recently noticed by Dr. Eben.
Watson, in his very able and valuable work on the " Local
Medication of the Larynx^^ (p. 82).

§ XI. — The Laryngismus of Convulsion and ofEjpilepsy.

There are tivo cases of sudden death in convulsion
and epilepsy : one of these is syncope ; the other, laryn-

92 POSTURAL RESPIRATION IX DROWNING

These events are not uncommon even, in that con-
vulsive affection designated laryngismus stridulus; and
I have met with an instance of the same kind in a little
girl, aged ten, afflicted with epilepsy; and another in
a youth, a medical student.

The fit of pertussis, so apt to pass into convulsion,
may also terminate in fatal apnoea, laryngismus being the
intermediate connecting link in both cases, and timeous
postural respiration the remedy in the latter.

In the laryngismus of these cases, the spasm, with its
apnoea, may continue so long that, when it has ceased,
the pneumogastric may no longer be excitable by the
contact of the carbonic acid in the lungs, and the
apnoea may issue in fatal asphyxia. It is at such a
moment that postural respiration would probably rescue
the patient from his danger.

The caution and proper instructions should be given
to every one having charge of the infant affected by
laryngismus stridulus, and to every parent having an
epileptic son or daughter. Fortunately the remedy is at
hand, and most easy of application.

I may take this occasion to place on record the sur-
mise that, in many cases of epileptic laryngea, the blood
remains over-charged with carbonic acid ; this may be
the source of the dark epileptic complexion ; the remedy
is the inhalation of dilute pure ammonia.

AXD OTHER FORMS OF APNCEA. 93

§ XIII. — The Laryngismus of Stryclinme.

Judging from many experiments, I believe that
strychnine destroys life in three ways :

1. By inducing laryngismus and apnoea;

2. By inducing exhaustion of the nervous power,
the effect of spasm and pain ; and

3. By a secondary asphyxia.

The^f<9^ object in the treatment is, of course, to get
rid of the poison. Emetics must be given. But if these
fail, the hopeful remedy is, to place the patient prone,
and, in the interval between the spasms, to tickle the
fauces with a feather or other object.

The second — the important remedy, is — tracheotomy.
In my experiments, I gave the same poisonous dose of
the acetate of strychnine to each of two dogs, and per-
formed tracheotomy in one ; and left them undisturbed
for the night. The one in which tracheotomy was per-
formed lived ; the other infallibly died I Tracheotomy
disarms laryngismus of danger — of its apnoea.

The third remedy is the postural method, with two
objects : the first, to administer respiration as the remedy
for the effect of the laryngismus, &c., and its apnoea or
suspension of respiration ; the second, adding tickling to
the fauces, again, to empty the stomach ; a third may be,
even when all spasm has ceased, to continue the alternate
pronation and rotation, that is — respiration, — in the hope
that life may be continued until the poison may be elimi-
nated from the system, as well as mechanically regurgi-
tated from the stomach.

94 POSTURAL EESPIEATION IN DROWNING

§ XIY. — The Laryngismus of Cliohing.

Death in choking is the result of a diastaltic or
reflex spasmodic closure of the glottis.

Nothing can be done in this stage of the accident,
except,

1. To endeavour, by introducing the finger into the
fauces, to induce vomiting ;

2. To introduce something like a hoiigie into the
oesophagus (a firm scroll of linen being the readiest); or,

3. To adopt a measure which I adopted on an emer-
gency, with immediate success, some years ago :

A little boy, eating some fowl in haste, attempted to
swallow too large a morsel^ and was choked ; I ran to
him, placed him between my knees, one knee (the right)
pressing firmly on the stomach, the other on the back ;
I then placed one hand (the left) on the back part of the
thorax, whilst I gave a firm blow with the other on the
sternum. In an instant I had the joy of seeing the morsel
of chicken expelled with force to a considerable distance ;
and all was safe !

But supposing all these efforts to fail. What is then
to be done ?

In the midst of the apnoea induced by the closure
of the glottis, the excito-motor power at length fails, and
the larynx is no longer spasmodically closed ; and now
postural respiration may be adopted, with the effect of
sustaining respiration and life, until such a bougie is

AND OTHER FORMS OF APNCEA. 95

made as shall be effectual in pushing down the morsel
of food or other object in the pharynx or oesophagus.

Kfirm scroll of cotton or hnen^ when imbued with
grease, made from a sheet, a window-blind, or curtain,
may be made, not in too great haste, and be boldly
passed into the cesophagus.

The morsel of food is generally lodged in the phar}iix,
or u][jper part of the oesophagus, and, when forced lower
down ceases to excite reflex action of the larynx ; and
breathing is, therefore, possible.

A thin bent tallow-candle, or a piece of firmish cord
(taken from the window-frame), might answer the purpose
of the bougie.

Postural respiration procures us the time necessary for
obtaining any of these means, and for giving full directions
to the assistants. In performing it, a little brisk move-
ment and even a smart blow may be adopted too in prona-
tion, and in making dorsal pressure, which may, if not at
first, eventually, dislodge the foreign body.

I need scarcely suggest that this last measure should
also be enforced in cases of a foreign body inhaled into
the larynx both hefore and after tracheotomy, with the
addition of a firm blow with the open hand, on the
back.

96 POSTURAL RESPIRATION IN DRO\VNING

§ XV. — On the Time the Patient may he suhnerged.

Many exaggerated accounts are on record in regard
to the length of time during which a patient may be
submerged, and yet recover.

The general principle has already been stated : the
higher the temperature, the more rapid the circulation,
the quicker the respiration, — and the greater the
necessity for air; the sooner, therefore, the apnoea will
become fatal asphyxia.

If a person be running, and fall into the water,
that fatal asphyxia will soon take place.

Skaters, warm with skating, speedily perish, though
life will be prolonged by the coldness to which they are
exposed.

Those who are without active exercise on the ice, and
therefore cold, will live longer if submerged in the
water.

But the duration of apnoea is longest in those who,
from any cause, experience a considerable reduction of
the pulse and of the temperature, of course within
physiological hmits : a degree of syncope occurring as
the person is submerged — from fright, for example — will
enable him to sustain the privation of air longer than
those whose circulation is vigorous. If a degree of shock
be sustained from the fall or plunge into the water, the
same effect may be produced.

It is in such circumstances that the long period of

AND OTHER FORMS OF APNCEA. 97

immersion said to have been sustained, must, if true,
be explained.

Sometimes the immersion is not constant or complete ;
as, ^Yllen the patient rises to the surface, or the water is
shallow ; and then life will, of course, be protracted.

In general, apnoea is more speedily fatal in summer
than in ^vinter, in the young and robust than in the
feeble, in the active than in the inert. I think it must
be admitted that very young children live longer, when
deprived of air, than adults.

These facts are confirmed by physiological considera-
tions, to be briefly detailed in Part the Third of this
little work. All, indeed, is physiology.

Two things are obvious, and of great practical value :
the first, that whilst we should not lose a moment in
adopting the postural respiration, we should not be
deterred from persevering by the apparent hopelessness
of the case, or the too ready desponding observations of
the bye-standers. We know not what event may have
occurred to reduce the circulation and the consequent
necessity for respiration.

All physiology, all experiment, the whole of the
works of Edwards and of M. Brown- Sequard, my own
investigations, all support these views, of which the
hibernant animal and the batrachian, present the most
marked illustrations. The differences amongst our
patients may be small ; but they are not the less real.

These considerations lead, especially, io perseverance,
in our breath-giving, life-giving, postural manceuvres —

98 POSTURAL RESPIRATION IN DROWNING

and the embers of life may be smouldering when we

thmh them extinct.

§ XVI. — Formula for Frone mid Postural Respiration,

I conclude Part Second by adducing the latest Rules
for the treatment of apnoea, in their most simple but
distinct forms, and suited to general, not to say univer-
sal, application.

They have never failed to produce good respiration,
in cases in which the pharynx and larynx have been free
from matters regurgitated from the stomach or expelled
from the lungs ; and these failures only apply to our ex-
periments with the Pnoeometer, not to our efforts to save
the patient ; for, in the prone position, even such events
find their instant remedy.

I believe I may assert that this mode of artificial
respiration will succeed in every case of apnoea ; it will
fail, I fear, whenever that aptoea has, by delay or other-
wise, passed into asphyxia.

The first object is to clear the Throat ;

The second, to Excite respiration physiologically ;

The third, to Imitate respiration ; and I have a
remark to make — not, I think, made before : it will be
observed that the process of imitated respiration begins,
not with inspiration, but with ^;rpiration, this being the
eft'ect of Wx'd prone position with dorsal pressure.

In the first place, it is obvious that in this manner

AND OTHER FORMS OF APNCEA. 99

we second the rule for clearing the throaty the effect of
mere position, by adding one which may clear the trachea
by inducing expiration ; it may be Irish respiration ; and
if, instead of pressure on the back, we apply a smart
llowy it may do more still.

In this, I believe, we imitate Nature too : the compres-
sion of the infant's thorax and abdomen as it passes, after
the birth of the head, through the vagina, must act in
the same manner, /r^^f producing /bm6/^ e:cpiration, and
so expelling all mucus from the air passages.

A similar event, issuing in good, has been seen to result
from effecting e^zjpiration by a strong effort of suction
by the mouth apphed to the mouth and nostrils.

The late Mr. Eeid invented a double-acting syringe,
the objects of which were, first, to induce ^^piration and
then ^?^spiration. I do not know whether it was ever
nsed. It may, I believe, still be seen in Eegent Circus,
Piccadilly.

Prone and postural respiration happily takes the
place of all such manoeuvres and instruments.

These measures are portrayed in the most simple
manner in the following table :

F 2

100 POSTURAL RESPIRATION IN DROWNING

RULES

FOR PRONE AND POSTURAL RESPIRATION.

I. Rules to he ajoplied in every Case.

1. Treat the patient instantly, on the s^ot, in the
ojoen air, exposing the face and chest to the breeze (except
in severe weather).

L^To Clear the Throat—

2, Place the patient gently on the face, with one
ist under the forehead ;

[all fluids and the tongue itself then fall forwards, leaving the entrance
into the wind-pipe free.]

If there be breathing — wait and watch ; if not, or if
it fail, —

//. — To Excite Respiration —

3. Turn the patient well and instantly on his side,
and —

4. Excite the nostrils with snuff, the throat with a
feather, &c. and dash cold water on the face previously
rubbed warm.

If there be no success, lose not a moment, but in-
stantly—

AND OTHER FORMS OF APNCEA. 101

III. — To Imitate Resjpiration —

5. Eeplace the patient on his face^ raising and sup-
porting the chest and abdomen tvell on a folded coat or
other article of dress ;

6. Turn the body very gently on the side and a
little heyond, and then briskly on the face, alternately ;
repeating these measures dehberately, efficiently, and
perseveringly fifteen times in the minute, occasionally
varying the side ;

[when the patient reposes on the cJiest, this cavity is compressed by the
weight of the trunJc, and expiration takes place; when he is turned on the
side, this pressure is removed, and inspiration occur si.

7. When the prone position is resumed, make
equable but efficient pressure, with brisk movement,
along the back of the ckest ; re?noving it gently im-
mediately before rotation on the side ;

[the first measure augments the expiration, the second commences in-
spiration.1

*»* The result is — Respiration ; — and, it not too late, — Life

IK — To induce Circulation and Warmth —

8. Eub the limbs upivards, with firm grasping
pressure and with energy, using handkerchiefs ; &c.

[by this measure the blood is propelled along the veins towards the hearth'

9. Let the limbs be thus dried and warmed, and
then clothed, the bystanders supplpng coats; &c.

10. Avoid the continuous warm-hath, and the position
on or inclined to the hack.

103 POSTURAL EESPIRATION, ETC.

II. Rides for the Treatment of the Still-born.

I. The first object is to clear the Throat and nostrils
of mucus.

1. This is best done by the prone position, pressure
along the back, &c.

2. By seizing it, as it appears, by a piece of soft
hnen.

II. The second object is, to imitate Nature, and
Excite respiration ;

1. The alternate hot and cold douche, or

2. The alternate hot and cold bath, or

3. Excitants apphed to the nostrils or the skin, are
the most efi'ectual measures.

III. The third, the all-important measure, is, to
Imitate respiration by

Alternate rotation, and pronation with pressure ;

IV. Next follow friction along the limbs upwards,
with flannel;

V. The continuous warm bath, as distinguished from
the sudden alternate hot and cold baths, is to be carefully
avoided, as causing loss of time and the neglect of all-
important remedies.

YI. Yery dilute vapour of pure ammonia should be
inhaled into the lungs.

CASES.

Recently a melancholy event occurred at Scarborough :

A gentleman^ bathing in the sea, was, as is supposed, seized with
cramp, and was only rescued from the water as life seemed about to
become extinct. The patient, instead of being treated instantly, on the
spot, was " conveyed," as formerly directed, to the bathmg-house : on
the way, he breathed several times ; on his arrival, he seemed irre-
coverably dead!

1 add another anecdote, not less deplorable :

A young person was bathing at Bov.logne-sur-mer , and ivas rescued
when nearly drowned. Breathing was partially restored, when the
superintendent of the " Societe Mumaine et des Nauf rages," as related to
me by himself, ivas very reluctantly indticed to place the patient in a warm
hath. The breathing ceased, and in this bath the patient expired !

CASES.

I. CASES OF DROW^'ING.

Case I. — By Br. Alexander , of Bundonald, Kilmarnock,

The first case which occurred, and in which postural
respiration was instituted, was that of Dr. Alexander ; and
it is full of instruction.

Though improving under the influence of this treat-
ment, it was thought proper to try the effect of the warm
bath ; the child grew worse !

The postural respiration was resumed, and it was
restored !

In a letter Dr. Alexander observes : " As I have
been the first to put your admirable method into practice,
probably I have been the first to notice the injurious
effects of the warm bath/^ " I believe the child would
have died in it, had it not been removed."

Dr. Alexander's case of the resuscitation of a still-
born infant is also the first saved by the postural method
of respiration.

To the Editor of The Lancet.

" Sir,— When Dr. Marshall Hall first published in
your columns, on April 12th, 1856, his Ready Method of
treating asphyxia, I felt so convinced of the soundness

106 POSTURAL RESPIRATION IN DROWNING

of the views then promulgated, that I resolved to test them
practically on the first occasion which should present
itself. I had not to wait very long for an opportunity
of doing so.

"On the 31st of May, 1856, 1 was sent for express to
visit a female child, aged two and a haK years, said to
have been drowned in a tubful of soap-suds. I had a
distance of fully two miles to ride, and started with a
feeling that my labour would be all in vain. Half an
hour must at least have elapsed from the time the child
was discovered in the water until I reached the spot. On
arriving, I found the child stripped of her clothes, wrapped
in a piece of flannel, reclining on her mother^s knee, and
people assiduously applying warm flannels to various parts
of the body, accompanied with frictions. The child
occasionally gave a sort of gasp or sob, with a slight
quiver of the body ; the eyes were projected and fixed,
and the pupils dilated : the pulse could not be felt.

"The postural movements, with upward frictions, as
recommended by Dr. Marshall Hall, were immediately
commenced, and after forty minutes' continuance, respi-
ration became more regular, but not so satisfactory as I
could wish. The child began to moan occasionally, and
attempted to cry ; the pulse could be distinctly felt, though
irregular ; but the eyes continued in the same immoveable
state, with dilated pupils, as when I arrived. In addition
to the postural movements, &c. &c., cold water was
dashed over the head, face, and various parts of the body.

" The child was then placed in a tub of hot water to

AND OTHER FORMS OF APNCEA. 107

the middle of the body, a cloth wet with hartshorn applied
over the region of the heart, and cold water poured upon
the head. Instead, however, of improving, the breathing
became more irregular, and spasmodic in its character.

" The child was therefore, after being five minutes in
the bath, removed, and the postural movements repeated
and persisted in for half an hour. The breathing again
became more regular and natural, the pulse more distinct
and firmer, yet the eyes continued iu the same state as
before.

" It was then evident that, besides the carbonic acid
which might be retained in the blood, there was conges-
tion of the brain, or some other state aHied to it, which
might be relieved by cautious depletion. A leech was
fortunately got and applied to the head, with most decided
relief, and, after a visit of two hours and a half duration,
I had the pleasure of leaving the child in the enjoyment
of a sound sleep, and in two days of seeing it quite well,
after two or three doses of aperient medicine.

'' I could not find out how long the child had been
under the water ; all I could ascertain was, that it might
have been one minute, but could not be more than five.

"In the case of a still-born child, from breech presen-
tatiouj on May 4th, ] 856, 1 had the satisfaction of seeing
the postural movements successful in restoring animation,
after htm^ persisted in for twenty minutes before the child
gave any signs of life.

"In a similar case, after a natural presentation, on the
28th Jan., I failed in restoring animation, though the

108 POSTURAL RESPIRATION IN DROWNING

Ready Method was tried for thirty -five minutes. I might
have continued the movements longer, but the mother
required my attention for some time, and I deemed it
vain afterwards to repeat them.

"Until your last number appeared, I had no idea that
any man or body of men, gifted with common sense,
would have had any doubts of the propriety of following
out the treatment recommended by Dr. Marshall Hall, in
all cases of asphyxia, from whatever cause. I have there-
fore contributed my mite to the list of cases already pub-
lished, confirming the soundness of the views entertained
and the treatment recommended by Dr. Marshall Hall,
and trust that every medical man will see it to be his
duty to follow out the Eeady Method on every suitable

Case II. — By Br. Hadden, of Skibbereen.

The second case of success in treating the drowned
by postural respiration is by Dr. Hadden, of Skibbereen.
I give it in Dr. Hadden^s own words, and add two ex-
tracts from a correspondence with that able physician :

" Skibbereen, Co. Cork, July 31, 1856.

" My dear Sir, — I think it right to inform you that
within the last few days I have had an opportunity of
trying your new method of inflating the langs, and I am
liappy to say the result has been most successful.

AND OTHER FORMS OF APNCEA. 109

" The case was that of a boy, about thirteen years of
age, who, when bathing, got a cramp in the right leg,
and, after struggling for a considerable period, sank ex-
hausted. He remained under water for many minutes,
and when brought to land appeared quite dead.

" I happened to be passing at the time, and imme-
diately put your plan into operation, and after continuing
it for more than a quarter of an hour, he began to show
some symptoms of returning animation.

" His recovery is the most remarkable I have ever
witnessed, and must have been impossible, if treated
according to the methods heretofore in use.

" With much respect, I am, dear Sir, very truly yours,
'' David Haddhin, M.D."

" Dr. Marshall Hall."

" Skibbereen, Aug. 12, 1856.
" My dear Sir, — I must rely altogether on the state-
ments of others as to the exact time during which my
l)atient was under water ; but, from a variety of circum-
stances, I believe he could not have been less than from
fifteen to twenty minutes completely submerged after he
had risen to the surface for the last time. The account
is, that he breakfasted at nine o^ clock, and immediately
afterwards went to bathe, in company with another boy,
about his own age= He had not been long in the water
when he complained of cramp in his leg, and called for
help to his companion, who immediately went to him,
but had not strength to render him effectual assistance.

110 POSTURAL EESPIRATION IN DROWNING

and with difficulty escaped being dragged to the bottom
by him. The alarm was then given, and assistance pro-
cured from a distance of at least an eighth of a mile ; but
when this arrived, the body could not be seen. A man
undressed, and dived in the place where the boy was last
observed, and, after much trouble, succeeded in bringing
him to the surface.

" I was driving near the place at ten o'clock, and saw
the body taken out of the water ; and so completely was
animation suspended, that even his own father, with
other bystanders, thought it quite useless to adopt any
remedial measures. However, I immediately spread a
woollen cloak on the ground, placed the body in the prone
position, and commenced the rotatory movements, having
given directions that a careful person should support the
head, while others were employed drying and rubbing
the legs and entire surface. The sun was very hot at the
time, and I left the body uncovered, to facilitate the
rubbing. I also held liquor ammonia under the nostrils,
and rubbed it over the region of the heart.

" For fifteen minutes, every exertion appeared useless.
There was then a kind of respiration established. The
breathing soon became loud, and accompanied by a kind
of moan, which continued for several hours. At eleven
o'clock, there was an attempt at vomiting, which was
near frustrating all our exertions, as a portion of food got
into the larynx, and had almost produced sufibcation.
At half-past eleven, he was taken home. From that
time, there was some return of consciousness ; but during

AND OTHER FORMS OF APN(EA. Ill

the entire day he had considerable pulmonary and cere-
bral congestion ; and this was followed by a severe attack
of fever, which continued for ten days.

" I am happy to say he is now completely recovered.
" I am, dear Sir, very truly yours,

" David Hadden."

" To Marshall HaU, Esq, M.D. &c. &c."

" Skibbereen, Sept. 24th, 1856.

" My dear Sir, — The idea I had formed of the case
was, that vital action had commenced with the deep in-
spiration and convulsive movements of the diaphragm
and abdominal muscles, converting the respiration, which
had previously been inaudible and purely passive and
mechanical, into active and independent breathing; the
pneumogastric (stimulated by long-continued artificial
respiration) being evidently the excitor. The trifacial
could not have had any influence in the first instance, as
the ammonia was not used until after the effort at
vomiting.

" I have lately used the rotatory movements with
success in the treatment of a still-born infant; but I
thought it necessary to increase the weight of the body
by gentle pressure, when in the prone position, and smart
slapping over the nates to excite vital action.

" I am, dear Sir, most truly yours,

" David Hadden."

" To MarshaU HaU, M.D. F.R.S."

112 POSTURAL HESPIEATION IN DROWNING

Case III. — By Br. A. Leg at, of South Shields.

I have peculiar pleasure in recording, as the third case
of the success of postural respiration, the following most
interesting one by Dr. A.. Legat, of South Shields :

" Having had occasion to visit a lady, three or four
miles distant, on the third instant, as I drove to the door
I was requested to go immediately to the coach-house to
see " an extreme case." On entering the harness-room,
I saw, stretched on his lack, before a warm fire, partially
enveloped in blankets, a muscular-looking young man,
surrounded by four or five others, one of whom was sup-
porting his head. The lips and face were blue, the sur-
face quite cold, and the body so rigid that the right hand,
which rested over tlie pubis, and the left arm, bent at
right angles over the chest, could not without difficulty
be changed from their position. No respiration could
be detected, and there was no pulse. A slight quivering
was observed throughout the body for an instant, and in
this movement seemed the only hope that life might be
restored. Exactly an hour had elapsed snice he was
taken out of the sea, and at that time he spoke a few
words. Blankets were taken down to the beach. He
was well rubbed. An attempt was made to administer
brandy, which it would appear he could not swallow, and
he was then carried about four hundred yards to the
room where I found him. He had been lying here about

AND OTHER FORMS OF APNCEA. 113

half an hour^ during which time he hod not spohen, and
for the last ten minutes of it he had been in the condi-
tion above described. Those around told me " they
feared it was too late to be of use to him.'"

I felt there was no time to be lost. The window of the
room was ordered to be thrown open, and placing my watch
on the floor before me, for the purpose of correct obser-
vation, I knelt down, and, with my right hand on his left
shoulder and my left on the side of his chest, commenced
the movements described by Dr. Marshall Hall. He was
rolled gently over on his face (the mouth and nostrils
being kept carefully free), and then back again on his
side " and a little beyond,^^ every four or five seconds.

About seven minutes had elapsed when I heard more
than one of the bystanders say, " it was of no use •" but
the movements were steadily persevered in, accompanied
with occasional slappings with the open hand over the
back of the chest, and nibbing of the limbs upwards by
two assistants. In twelve minutes I first detected indi-
cations of returning respiration, and in six minutes more,
accurately noted, the breathing was natural. I then
made him swallow a little brandy, and saw liim again in
half an hour, before I left, perfectly safe.

" Remarks. — Three months have just elapsed since
the short, but excellent rules, from the able pen of Dr.
Marshall Hall, for the restoration of the drowned, appeared
in The Lancet, and now the second instance of remarkable
recovery by their means is recorded. I could conceive
no case which could put this new method more severely

114 POSTURAL RESPIRATION IN DROWNING

to the test than the present one. Every attention had
been paid to the man from the moment he was removed
from the water — warm blankets, continued rubbing of
the body, the application of mustard, the administration
of brandy, removal to a warm fire, &c. ; and yet, not-
withstanding all this, instead of getting better, he grew
worse, and must inevitably in a few minutes more have
been beyond all reach of art. And why ? Because his kind
and attentive neighbours, although doing their best for
him, had been pursuing a plan opposed to his re-
covery.

Three causes evidently operated against the poor man :
1st. the attempt to give brandy, which he could not
swallow j 2ndly. the carrying him nearly four hundred
yards ; and 3rdly. the placing him ^lpon his hack ; all of
which, in his enfeebled condition, must have tended to
reproduce and prolong the asphyxia. An hour elapsed,
postural respiration was tried, under these disadvantages,
and in eighteen minutes the respiration was free !

" It would be well if the Eoyal Humane Society would
withdraw their old " Eules," so liberally scattered about,
and replace them with the concise and simple instructions
of Dr. Marshall Hall. Ordinary intelHgence and perse-
verance, with a knowledge of such rules, I feel certain,
would be the means of saving very many lives.

" I beg also to suggest to my professional brethren
this plan for the purpose of resuscitating patients thrown
into a critical condition from the administration of chlo-
roform. The present method of seizing the tongue with

AND OTHER FOEMS OF APNCEA. 115

the forceps to pull it forward will be unnecessary, and com-
mand over the respiratory organs will be found to be
surprisingly great."
" November, 1856."

Case 1Y. — Imjproperly treated— fatal. By Br. A. Begat,

I am indebted for a second case to Dr. A. Legat —
full of the deepest interest and instruction.

The nttle patient was five years old. He gasped
when first rescued from the water, and would surely have
been restored by instant postural respiration. Instead
of this, the warm-bath was used; the child was lost;
at last postural respiration loas tried ; but the state of
apnoea had passed into fatal asphyxia ! — a sad commen-
tary on a proposition noticed in the foregoing pages.

" South Shields, June 4th, 1857.

" Dear Sir,- — As I believe you will be glad to hear
some particulars of a case where the " Eeady Method"
has been tried by me a second time, although unsuccess-
fully owing to previous loss of time in improper treat-
ment, I beg to forward you the following notes :

" When visiting a patient on the evening of the 4th
ultimo, a messenger requested me to go with him imme-
diately to see a child supposed to be drowned. The
house was not a quarter of a mile distant, and as my
conveyance was at hand, I saw the little patient within a
couple of minutes.

116 POSTURAL EESPIRATION IN DROWNING

" The room was a small one, and crowded witli
neighbours. The child was undressed, the lower extre-
mities in warm water, and warm wet blankets were placed
over the body, which was quite flaccid. The face and
lips very livid, the tongue slightly protruding beyond the
teeth ; a little frothy mucus surrounded the nostrils ; and
the pupils were considerably dilated. There was no
respiration, or pulse.

" He was carried to the door instantly, and treated
after your excellent method. I began the movements
precisely at eight, p. m. — continued them steadily for
about twenty-five minutes, when Mr. Young, another
medical man, arrived. We persisted steadily for one
hour and five minutes, when it became so dark, we judged
it excusable to desist.

" During the movements, small quantities of fluid,
with some half-digested food, came from the stomach,

" What had occurred before I saw the boy, I learned
subsequently. There was a variety of statements on
this point ; but the following one, made by the father,
seemed most consistent and correct. The little fellow,
five years of age, left his nurse about half an hour before
I saw him, accompanied with another child, went to a
pond about 100 yards off, and fell in almost immediately.
He was supposed to have been in the water fifteen or
twenty minutes — was taken out by his father, who said
he gave two little gasps — and was conveyed to the house,
and placed at once in the warm bath. This occupied but
a short time ; but in the meanwhile the little patient was
irrecoverably dead !

AND OTHEE FORMS OF APNCEA. 117

^' Who can doubt that the boy would have been res-
cued by the " Eeady Method/' used instantly by the side
of the pond, wliere he gasped ?

" Believe me, dear Dr. Marshall Hall, yours very
truly,

'' A. Legat."

*' Dr. MarshaU HaU, F.KS."

Case Y. — By Ernest P. TFilkms, Usq. of Newport.

My fifth case is by Mr. Wilkins, of Newport. Though
briefly detailed, it is also full of interest :

" Newport, Isle of Wight, March 18th, 1857.

" My dear Sir, — I have adopted your discovery in
several cases with perfect success.

'^ A female, aged thirty-two, in a moment of rage,
threw herself from a bridge into our river. I was not
perfectly satisfied that the asphyxiated condition in which
I found her arose from drowning— although it might
have done so — because the depth of water was not above
the knees. Some of the parties who picked her up said
she was not long enough in the water to be drowned ;
others said she was drowned. I attributed the apnoea to
the shock to the nervous system produced by the fall
from the height, from fifteen to twenty feet ; she pitched
on the nates ; or to the exposure to cold, it being a bitter
night, and she was dragged a long distance in the water

118 POSTURAL RESPIRATION IN DROWNING

to reach the landing place. It might perhaps arise from
combined causes.

" I was soon on the spot, and in the language of the
bystanders found her dead — in other terms, asphyxiated.
I commenced your Eeady Method, and continued it for
upwards of an hour, with perfect success, to the amaze-
ment of her friends who assisted me.

" The other cases were suspended animation from
childbirth, of which so many cases are on record.

" I shall be happy to reply to any questions on the
foregoing case, if you may desire further information.

" Believe me, with sincere respect, faithfully yours,
" Ernest P. Wilkin s."

" Dr. MarshaU Hall."

Case VI. — Bi/ Mr. Richard Ellis, of Bishops-AuMand,
Bur ham.

My sixth case is from the able pen of Mr. Eichard
EUis, of Bishops-Auckland. It must be a severe case
in which convulsion occurs, and great confidence in the
means is shown by its second judicious repetition :

" To the Editor of The Lancet.

" Sir, — On the evening of the 1st of this month,
about seven o'clock, I was called to see a boy who, I was
told, had just been taken out of a deep pond, situated in
a brickfield near this town. I arrived at the patient's

AND OTHER FORMS OF APNCEA. 119

house just as they were in the act of carrying liim in,
apparently lifeless. He was a thin, delicate child, be-
tween seven and eight years of age, and he presented tlie
following unpromising symptoms : — Eespiration entirely
suspended; action of the heart inaudible; coldness of
the entire surface of the body ; pulse imperceptible at the
wrist ; great lividness of the face, and turgescence of the
superficial veins of the neck. I immediately had the wet
clothes removed, and placing the body on a blanket
spread on the floor, proceeded to carry into execution
the plan recommended by Dr. Marshall Hall for restora-
tion in such cases, turning the patient on his side and a
little beyond, making pressure pn the spine, and exposing
the face and chest to a current of cool air. When I had
continued these movements repeatedly each minute for
about half an hour (at the same time using friction of
the body perseveringly), I was deHghted to hear one or
two gasping attempts at respiration ; and in about another
half hour, the circulation became so far restored as to
admit of his being removed to bed. Here, however, he
had a severe attack of convulsions, which continued so
long as to compel me to repeat the postural movements
for some minutes. The temperature of the body now
increased rapidly ; and at the end of two hours from the
time of my first seeing him, he became so far restored as
to swallow a little, and to be conscious of the presence of
his friends. The reaction and consequent fever were
moderate, and the boy has now quite recovered from the
effects of his accident.

120 POSTUEAL RESPIRATION IN DROWNING

" From inquiries which I have made since^ it appears
certain that the child was submerged for at least Jive
minutes, as he had to be extracted from the mud in the
bottom of the pond by means of a ladder.

" I remain, Sir, your obedient servant,

" Richard Ellis, L.R.C.S. Edin/'

" Bishops -Auckland, Durham, June, 1857."

Case YIT.~Ow board the Dreadnought, ly
F, M. Corner, Esq.

" Henry Bullivaul, setat. eleven, fell from a boat into
the Thames, immediately became submerged, and was
carried by the tide a distance of about one hundred yards,
when he became entangled in the moorings of the Dread-
nought, ten feet beneath the surface. Allowing the
shortest time of submersion, he was under water five or
six minutes ; and in three minutes more he was on board
the hospital.

" I saw him directly, and found respiration ceased and
his face and lips livid, and he was to appearance dead.
I did not examine for the pulse, regarding that of little
moment, but at once resorted to the " Ready Method ;"
at the same time having his clothes removed, and the
body rubbed dry. After two or three rotations, there
was an inspiratory effort, succeeded, shortly, by others,
at intervals of about half a minute. He soon breathed
regularly, but faintly, and at long intervals ; and during

AND OTHER FORMS OF APNCEA. 121

the intervals I performed artificial respii-atioii^ and occa-
sionallj applied strong ammonia to the nostrils, and
slapped the chest smartly with my flat hand; all,
I am satisfied, with benefit. In about ten minutes
he was sensible, spoke, and took a few teaspoonfuls of
brandy and water, shortly followed by vomiting of appa-
rently Thames water. He now breathed tolerably well,
and only complained of cold ; and a hot bath being ready,
I placed him in it for two or three minutes, giving him
a little brandy. After this, he was wrapped in blankets,
a mustard cataplasm applied to the front of the chest, and
left.

" P. M. Corner."

II. CASE OF SUFFOCATION.

Case YllI — Of a Man overwhelmed hj the fall of Earth ;
communicated by James F. West, Esq.

" The attention of the profession having been recently
called to the mode of performing artificial respiration
suggested by that distinguished physiologist. Dr. Marshall
Hall, I think it may not be uninteresting to publish the
details of a case which, from the severity of its nature,
must be considered as an ample test of its merits, as a
mode of relieving suspended animation in cases of
asphyxia.

The patient was completely asphyxiated, having
been covered by a mass of earth for three-quarters of

G

122 POSTURAL EESPIRATION IX DROWNING

an hour ; yet perseverance in this method of treatment
sufficed to restore him to a state of safety in a compara-
tively short space of time. Prom the notes of the case
I have made the following abstract :

" James S , a stout, plethoric, healthy man,

thirty-eight years of age, was admitted into the Queer/s
Hospital, Birmingham., under the care of Dr. Heslop, at
a quarter to one o^ clock in the afternoon, on April 28th,
in an almost inanimate state, breathing convulsively and
stertorously, the respirations being not more than four or
five in a minute, with a scarcely perceptible pulse, the
face pale, and the general surface of the body cold and
bloodless.

The history of the case, as obtained from his fellow
labourers, was, that while he was engaged, about
midday, in constructing a sewer, the earth around him
gave way, and he was completely buried to the depth
of about ten feet. Twenty minutes elapsed before the
soil was removed from around his head, and at least three
quarters of an hour before the whole of the body was
extricated. A cab having been at once obtained, he was
conveyed to the hospital. No appearance of injury on
any part being apparent, and there being no such evi-
dence as bleeding from the nose or ears to warrant a sus-
picion of fracture of the base of the skull, but the sym-
ptoms being rather such as might be accounted for by
the circulation of non-arterialized blood, I determined to
put in practice the Marshall HaU method of artificial
respiration. With the assistance of my friend Mr. Mould,

AND OTHER FORMS OF APNCEA. 123

by whom the most valuable aid was rendered during the
entire operation, the man was stripped, cold water was
dashed on his head and face, and the postural movements
commenced. Hot flannels were applied to the lower
extremities, and friction towards the centre of the circu-
lation unremittingly kept up. During the first quarter
of an hour, but little improvement was visible ; perfect
coma existed ; not a sound escaped his lips, and there
was not the slightest muscular movement ; hut during the
second quarter, a marked amelioration of the symptoms
took place. The livor gradually left the lips, and the
countenance resumed a more natural aspect ; the pupils,
wliich were at first much though equally contracted, be-
gan to dilate ; the pulse, though still intermittent, became
more frequent and regular ; an attempt at vomiting was
made, but nothing but a little water containing gritty
matter was thrown up ; and lastly, he began to move his
arms spasmodically, and by the action of the muscles of
forced inspiration to endeavour to dilate his chest. At
the end of three quarters of an hour, the pupils were in-
tensely dilated ; the skin had become warm ; inarticulate
sounds began to escape his lips ; and the muscular move-
ments were stronger and more frequent.

The breathing, which was still laborious and ster-
torous, almost ceased, when the patient was laid on his
back, and the artificial respiration discontinued.

" The Read?/ Method loas unceas'ingly kept njjfor an
hour and a half; and at the end of that period the re-
spiration was performed naturally, though slowly, and

G 2

124 POSTURAL EESPIRATION IN DrvOWNING

with some difficulty. The skin was hot, the face flushed,
the vessels of the conjunctiva injected, the veins of the
head and neck turgid; the pulse had risen to 70, but
was perfectly regular.

" The patient was then placed in bed, and held in
the recumbent posture by two assistants, as he was very
violent, and restraint was imperatively called for. Vene-
section to the amount of twelve ounces was now per-
formed ; the blood, which came in a good stream, was
quite black, but became florid on exposure to tlie air.
The respiration was much relieved by this procedure, and
subsequently took place with greater regularity, less
stertor, and diminished efl'ort. He still continued to
writhe about in bed; but his efforts were much less
violent : warmth was kept up by hot blankets, &c. To-
wards eight, p, M. the breathing again became slow and
laboured, and the pulse fuller and more frequent. By
the advice of Dr. Heslop, twelve leeches were applied to
the temples, and the bleeding encouraged by hot fomen-
tations. Respiration was now performed very cjuietlj
and regularly ; the pulse was natural ; but there was no
sign of consciousness, and he lay apparently in a state of
stupor, muttering incoherently at intervals, and picking
the bed-clothes. About nine p. m. he passed a stool in-
voluntarily. At eleven p. m, an enema, containing half
an ounce of turpentine, two ounces of castor oil, with
half a pint of gruel, was administered, and followed by a
copious evacuation.

" The patient slept pretty soundly during the re-

AXD OTHER FORMS OF APNCEA. 125

mainder of the night, and on awaking, about eight in the
morning, he recognized his wife, who was standing bj
his bedside, though he was unable to answer questions
pertinently, and remained in a state of semi-conscious-
ness during the rest of the day. He continued heavy
and lethargic, complaining considerably of headache, dur-
ing the two following days ; and he was not perfectly
rational till Saturday, May 2nd, when, his state being
such as to warrant his discharge, he was permitted to
leave the hospital/'

IIT. CASES OF STILL-BORN- INFANTS.

Case IX. — By Marshall Sail Higginhottom, Esq.
of Nottingham,

The following case possesses a peculiar value, on
account of the accuracy with which it was observed ; and
especially from the fact, first noticed by the author, of
bubbles of mucus blown out and drawn into the nostrils
— a sort of natural Pnceometer. It was particularly
noticed afterwards by Mr. Charles Yaudin and Dr. Ni-
cholls. It is of great moment to be able to observe that
there really are expiration and inspiration in pronation
and rotation ; for it is of vital importance to know that
the air-passages are/r^^ ;

" Carltoa Street, Nottingham, Dec. 21st, 1856.

" ^ly dear Uncle, — ^ ^ ^ ^ Early this morning I
attended a lady in her confinement. The presentation

126 POSTURAL RESPIRATION IN DROWNING

was a breecli one, and there was much and unavoidable
pressure upon the umbiHcal cordj which ceased to pulsate
a quarter of an hour before the child was born. When
born, the child was quite livid, without perceptible move-
ment of the heart, and indeed to all appearance dead;
and, under ordinary circumstances, I should not have
entertained the slightest hopes of its resuscitation.
By adopting your method, I had the great satisfaction of
seeing it fully restored to life in about twenty minutes,
when it cried lustily — the nurse and friend being amazed
at the result. Being the only son in a large family of
daughters, the parents' delight was proportionately great.
I explained to the father that he had to thank you for a
living son. •5«- -^ -^ -^

" Believe me, my dear Uncle, your affectionate
nephew,

" Marshall Hall Higginbottom."

" Dr. MarshaU HaU."

" Carlton Street, Dec. 25th, 1856.

" My dear Uncle, — I lose no time in sending you a
more particular account of the phenomena observed in
the case of the still-born infant which I mentioned to
you.

" The child was livid, and the lips purple, and there
was no perceptible action of the heart.

" Upon commencing the postural treatment, I noticed
that with each induced expiration a quantity of air, de-
noted hy buhbles of tenacious frothy mitcus, issued from

AND OTHER FOUMS OF APNCEA. 127

nostril, the huhhles receding on induced inspiration.
I saw the necessity of this mucus being removed eacli
time, in order to allow the free entrance of air, respira-
tion being apparently carried on entirely through the
nostrils ; for although there was mucus also between the
lips, it was not at all disturbed during the postural
changes.

'^ Continuing the treatment for about ten minutes,
the mucus ceased to flow, and a very slight action of the
heart became perceptible. This ceased, if there was any
remission of the treatment ; but returned when the pos-
tural proceedings were renewed.

" In fifteen minutes the action of the heart became
stronger, and dashing cold water upon the face and chest
now produced a forcible inspiration ; after which, and for
the first time, respiration appeared to be carried on
through the mouth.

" The countenance, which had gradually become less
livid, now assumed a natural appearance, and in twenty
minutes the child was quite restored, and cried vigor-
ously.

" Your affectionate nephew,

" Marshall Hall Higginbottom.'^

" Dr. MarshaU Hall."

128 POSTURAL EESPIRATION IN DROWNING

Case X. — By Charles Vaudin, Esq. of St. HeUer's,
Jersey.

" 60, ^ew Street, St. Helier's, Jersey, Feb. 10th, 1857.

'' Dear Sir, — Truly has it been said that medicine in
judicious hands is the handmaid of Nature.

" As truly may it be said that your thoughtful and
ingenious application of great principles and natural laws
to the treatment of diseases and accidental exigencies
must be ranked amongst one of the greatest discoveries
of modern medical science ; for they have, since the short
period of their first promulgation, been the means of
saving many lives that would have been otherwise lost.

" The enclosed I have thought worthy of record, as
exemplifying in a remarkable degree the truth of the
princijolej as well as the success, of the " Marshall Hall
Method."

" The desire of adding testimony to a great truth,
which, like all others, is too slow in being received and
appreciated, and the wish of seeing honour given to whom
it is due, are the only apologies I have to offer for ad-
dressing you.

" Believe me to be. Sir, yours very truly,

" Charles Yaudin, M.R.C.S. &c."

" Dr. Marshall Hall."

" Mrs. D , a lady of exceedingly delicate consti-
tution, aged twenty-six, was taken in labour of her second

AXD OTHER POKMS OF APXCEA. 129

child on the second of January, at seven a. 5r. She had
suffered trifling pains two days before, and had not felt
the motion of the child since they commenced. I saw
her at nine, and found her then suffering from frequent
but ineffectual pains. The vagina and external parts
were hot and dry ; the os uteri dilated to the extent of a
shilling; its lips thin, dry, and umielding; membranes
entire; and head presenting. A careful stethoscopic
examination of the abdomen failed to detect any sounds
of the foetal heart. The pelvis was small, but not de-
formed.

" At seven a. m. on the 3rd, I delivered her of a
delicate male child. Around its neck were two folds of
the funis, in which I could not detect the slightest pul-
sation. It was cut and lightly ligatured. The surface
was flaccid, cold, and very livid ; the lips blue ; the palms/
soles, and a small surface over the nates, were quite sod-
den, and partially exfoliated. Entire absence of all
reflex action. The pupils were insensible to light, the
nose to ammonia, and there was not the slightest appre-
ciable motion in the prsecordial region. The usual reme-
dies, except sufflation and the hot bath, were tried with-
out success. Suspended animation could hardly be more
pronounced or akin to death.

'' The " Marshall Hall Metliod" I persevered in for
twenty-six minutes, accurately noted by my watch before
me. The postural movements were made upon warm
blankets frequently changed. Then the funis began to
bleed ; about one drachm of blood was lost, and it was

130 POSTURAL RESPIRATION IN DROWNING

secured. The countenance had before this undergone a
marked change, had become mottled and red. My ob-
servations of the respiratory action coincided exactly with
Mr. M. H. Higginbottom^s ; viz. " with each induced
expiration, a quantity of air, denoted by bubbles of a
tenacious frothy mucus, issued from each nostril, the
bubbles receding on induced respiration." I could now
distinctly discover a slight fluttering action of the heart.
After twenty- nine minutes, and following an induced ex-
piration, I noticed a tremor of the skin and muscles over
the epigastrium, followed by a sudden voluntary inspir-
ation, the chest becoming forcibly distended and fixed,
renderinsj its diaphragmatic boundary tense, and, as well
as itself, resonant as a drum all over. The chest re-
mained in this fixed position for nearly two minutes, the
intercostal muscles being very prominent, the postural
motions still going on, and I began to think all my efforts
ended here, when the child made a voluntary expiration,
attended by a cry ; the movements and frictions were
made with redoubled energy, and I soon had the gratifi-
cation of hearing the infant (;ry loudly enough, and
breathe alone, as well as empty its bladder vigorously,
thirty-three minutes having elapsed. The door and a
window of the room were kept open, and the process
carried on near the former, to ensure a supply of fresh
air. The child has been subsequently dry nursed, and is
doing well."

AND OTHER rORlIS OF APNCEA. 131

Case XI. — By Dr. Nicholls, of Wiveliscomhe, Somerset,

" "Wiveliscombe, Somerset, Feb. 6th, 1857.

" Dear Sir, — With much pleasure and satisfaction I
send you a very short account of a case of asphyxia in a
new-boin infant, treated by youj invaluable plan.

" On Tuesday, Tebruary 3rd, at four p. m. I was
called some miles, through frost, snow, &c. to a poor
woman who had been in labour three days, and who,
strange to say, out of eight labours, has five times had
arm presentations, and twice placenta prsevia. I found
part of the placenta and both arms presenting, and, after
very great exertions, delivered her by turning of an appa-
rently dead child. Por three or four minutes I was so
much engaged with the mother, who was in a state of
great prostration, that the child was not attended to. I
then treated the child on your plan, although with very
faint hopes of success ; but after rather more than half
an hollies exertions, much to my satisfaction, and to the
nurse's and mother's astonishment, circulation and respir-
ation were as strong as I ever saw in a new-born child.
I feel quite sure that hot water, friction, brandy, &c.
would have been useless in this case.

" Mr. M. H. Higginbottom's case was very much
like mine ; as I noticed the frothy mucus which came
from the nostrils ; and this gave me great trouble, as the
nurse would give me no help in a case which she thought
hopeless. I may add that I saw the little patient this

132 POSTURAL RESPIRATION IN DROWNING

morning, and she is as strong as any child of three days
old.

" The weather was very cold, and I quite think with
you that cold protracts latent vitality, and gives you a
greater chance in these cases.

" I am, dear Sir, yours very truly,

" James Nicholls, M.D."

♦' MarshaU Hall, M.D. F.R.S."

Case XII. — B;y J. T. Savory, Esq. of Wendover,

" To the Editor of The Lancet.

" Sir, — If you think another case of asphyxia, suc-
cessfully treated by the " Marshall Hall method," worthy
of notice, please to give it a corner in your widely circu-
lated journal.

" At three o^clock- a. m. on December 29th, I was
called to a case of placental presentation. On arriving
at the house of my patient, I found her in an alarming
state of syncope, from excessive hsemorrhage. I imme-
diately attempted delivery by turning ; the child (a boy)
being large, I had a good deal of difficulty in liberating
the head from its pelvic prison, some considerable time
and much exertion on my part being required, the mother
having no uterine pains to assist in the expulsion.

" When the child was born, I observed it was per-
fectly asphyxiated ; but my chief anxiety being to do all
I could for the mother, my. attention was not directed to

AND OTHEE FOEMS OF APXCEA. 133

the infant for several minutes. It then appeared quite
inanimate. However, thinking it a good opportunity to
try " Dr. Marshall IlalFs method" in cases of asphyxia,
I proceeded according to the plan laid do^^qi by him, and
after persevering unremittingly for a quarter of an hour,
the child gave a slight and short inspiration; and in
three minutes more, another inspiration took place; after
this, the infant breathed once in a minute for a short
time, and then more frequently and deeply ; at length he
opened his eyes ; and at the expiration of half an hour,
he breathed freely, and cried as strongly as a healthy
child.

'^ Two female friends of the patient were present, and
they frequently expressed a positive opinion that it would
be perfectly useless to continue any attempts at resusci-
tation, the nurse at the same time exclaiming, " Ah, Sir,
you may turn and twist that child about as much as you
like, but you will never bring it to life." Their surprise
was great indeed when at length the child began to show
signs of animation.

" I take to myself no credit in the treatment of this
case, being merely an humble follower of the scientific
and valuable directions given by Dr. ^larshall Hall.

" I am, Sir, your obedient servant,

" J. T. Savory."

" "Wendover, January, 1857."

134 POSTURAL RESPIRATION IN DROWNING

Case XIII. — By J. C. diappell, Esc[. George Street,
Hanover Square,

The interest attached to the present case is in the
fact of the infant being born prematurely, at six months
and a half. It was restored to Ufey even although scarcely
likely to live :

" The child was stiU-born ; no pulsation at the wrist
or beating of the heart to be detected. I pursued your
plan steadily for fifteen minutes (the nurse evidently
thinking me a lunatic) ; at the end of which time, I found
the heart beat, and, in five minutes more, heard as loud
a cry as could be expected from a 6i-months' child.
The infant still lives ; but that it may be reared, appears
very improbable.

" I found no difficulty whatever in appljdng the
postural changes to the infant in question ; in fact, its
diminutive size rendered the operation easier j a second
person performed the frictions upwards.

" I commenced by clearing the mouth and fauces of
mucus, which abounded and afterwards came away in
considerable quantities. The child, at its birth, had a
dusky hue. Tor thirteen or fourteen minutes, I found
no sign of vitaHty ; but in one or two minutes more, I
felt a slight quiver under my right hand (which grasped
the left side of the chest), and almost simultaneously
heard a mucous rattle in the throat ; an instant after, I

AND OTHEIl FOEMS OF APNCEA. 133

could discern pulsation of the heart. I again cleared
the mouth and throat of mucus, continued the postural
movements, and, at the expiration of four or five minutes
more, tlie infant gave a cry as loud as could be expected,
considering it was at most a seven months' child."

ADDITIONAL CASES.

Case XIV.

" Bognor, Sussex, January, 1857.

" Dear Sir, — Having read in The Lancet your valu-
able method for the restoration of the drowned, I resolved
to try it in the first case of suspended animation which
might come under my care.

" On the 26th of December last, I was called to

attend Mrs. , in labour with her first child ; and on

making an examination, I found the operation of turning
was required, which I performed. When the child was
born, I found it was perfectly asphyxiated. I imme-
diately commenced your resuscitation process, and having
continued it for about ten minutes, the nurse observed
(to use her own words), " Ifs no use your trying any
longer. Sir; it\s dead enough."

" Being determined to give the process a fair trial,
I continued it for about twenty minutes, when the child
gave evidence of life, and shortly after cried out ; respir-
ation was established. The child lived fourteen days,
and died from debility, the woman not having gone her

136 POSTUEA.L RESPIRATION IN DHOWNING

full time ; wliicli tends to strengthen the superiority of
your process over every other for the restoration of still-
born children.

" I make no apology for sending you this case, be-
lieving that you will be pleased with the successful treat-
ment of it, for which 1 am indebted to you.

" I am, Sir, your obedient servant,

" Charles Osborn, M.E.C.S."

" MarshaU Hall, Esq. M.D."

Case XY.

" To the Editor of The Lancet.

" Sir, — Considering it the duty of all who have tried
with success Dr. Marshall Hall's method for recovering
new-born infants in whom all respiration has ceased, to
communicate the result of their experience to the public,
I am induced to forward the following case :

" Last Sunday morning, I was called to attend Mrs.

M , in labour. After a short time, the child was

born, and duly handed over, alive and apparently well,
to an attendant. For some time I was rather anxiously
engaged with my patient, who was very much disposed
to haemorrhage (from which she suffered seriously after
her last labour). Having seen every thing right and
safe with her, I was attracted by the quietness of the
infant, when, upon looking at it, I found all respiration
had ceased. I instantly commenced Dr. Marshall HalFs

AND OTHER FORMS OF APNCEA. 137

methoci, with the happy result, in ten minutes, of deUver-
ing up to the friends the infant ahve and crying.

" Apologizing for trespassing on your columns, I aiii,
Sir, your obedient servant,

'' H. S. Chavasse."

" Sutton Coldfield, Jan. 19tli, 1857."

Case XVI.

" Winslow, Bucks. January 30, 1857.

" Sir, — A case occurred in the practice of Mr. Denne,
in this town, last night, illustrating the great advantages
of your Ready Method. In a case of confinement, after
a very lingering time, the delivery was completed by
forceps. When the child was born, there was an im-
mense scalp-tumour, and the usual symptoms of pro-
longed asphyxia were present — so much so as to cause
a doubt in my mind whether even your Ready Method
would perforin almost a miracle, and resuscitate the
child.

" However, I placed the child in the prone position,
and then commenced turning it with the right hand on
the side of the chest, the left supporting the head. The
movement was repeated about once in a second (such as
is marked by the penduhim of a large clock), and after
its repetition about twenty-three times, I had the satis-
faction of hearing a cry, at first faint, but not by any
means so afterwards:

138 POSTURAL RESPIRATION IN DROWNING

" The time which elapsed from the first movement to
the cry was about seven or eight minutes ; and I may
add, that the cord was cut prior to the child being
touched, and that no other means whatever were tried
but the rotatory motion. The astonishment of the women
around the bed was excessive, and they firmly believe
that a method will be found almost to return the dead to
life. The child is alive and well, and adds another name
to the list of lives that have been, and will be, saved by
the Eeady Method.

" I have the honour to be. Sir, your obedient servant,

" Thomas Newham.''

" MarshaU Hall, M.D."

Case XVII.

" To the Editor of The Lancet.

" Sir, — Within the last three weeks, I have had two
opportunities of trying the Eeady Method in the asphyxia
of newly born infants. One was a case of turning, on
account of arm-presentation ; the other was a presenta-
tion of the breech. In both instances, the heart's action
was barely perceptible ; no pulsation could be felt in the
cord, and no inspiratory effort could be detected. After
rotating the trunk five or six times, inspiration com-
menced, and in a short time respiration became fully
established, so that the children were able to cry vigor-
ously. I purposely abstained from using any other means

AND OTHER FOUMS OF APNCEA. 139

of resuscitation. My experience of these two cases would,
as far as it goes, lead me to consider Dr. Marshall HalFs
method as far more prompt and effectual than any of the
means which we had previously been accustomed to use.
" I am, Sir, your obedient servant,

" J. G. SWAYNE,

" Physician- Accoucheur to the Bristol General Hospital,
and Lecturer on Midwifery at the Bristol Medical School."

" Clifton, March, 1857."

Case XYIII.

" Gainsborough, Feb. 7th, 1857.

" Sir, — I have much pleasure in adding another to
the list of lives saved by your valuable discovery. The
facts of the case are as follow, and in some respects simi-
lar to one reported in to-day's Lancet :

" I am assisting a practitioner in this town, and on
Thursday evening last, the 5th instant, I was called to a
woman in labour at the workhouse. On my arrival, at
half-past eight p. m. I found the head presenting, and
with it a loop of the funis, the pulsation of which had
entirely ceased. I found it impossible to replace it, and
in half an hour the woman was delivered of a child appa-
rently quite dead. The usual means failing to restore it,
I at once commenced the Eeady Method. After ten
minutes^ trial, the child gave a feeble gasp, and it con-
tinued to do so at every ten or twelve turns. The inter-

140 POSTURAL RESPIRATION IN DROWNING

vals between these respiratory movements soon became
shorter and shorter, and in half an hour it breathed of
its own accord. It appeared, however, in a semi-comatose
state for some time, and was three hours before it became
warm and could move its limbs. Even then, the heart
beat very feebly, and at only half its normal frequency at
birth ; and it did not entirely recover until six o'clock
the following morning. At the present time the child is
doing well, and is as likely to live as any other new-born
infant.

" Should you desire more minute particulars, I shall
be happy to furnish them, and am. Sir, yours faithfully,
" Edward Capron, M."R.C.S. & L.S.A."
" Marshall HaU, M.D. F.E.S."

Cases XIX and XX.

"17, Paddington Green, Feb. lOth.
" Dear Sir, — I take the liberty of communicating to
you two cases in which your Eeady Method was em-
ployed with perfect success. In the first case, the child
had been born suddenly ; for nearly ten minutes before
my arrival, tlie umbilical cord was twisted round its neck,
and the soiled clothes of the mother completely smo-
thered it. The usual remedies of dashing cold water, &c.
failed to restore it, and after five minutes your Ready
Method was employed. In a few minutes the child
gasped, and eventually slowly recovered.

AND OTHER FORMS OF APXCEA. 141

" The second case was a nates presentation in a
primipara : the head occupied seventeen minutes in
passing; there was great li\ddity in the face and neck,
and no pulsation could' be detected in the heart or cord.
Perseverance with the Keadv Method for several minutes
was crowned with success. The child is now nearly two
months old.

^' 1 certainly think that in the " olden time" these
cases would have been turned over to the sexton.

" I am yours obediently,

'' J. S. Beale.

" Dr. Marshall Hall."

Case XXI.

" Detroit, Michigan, U. S. April 1st, 1857.

^' On the ISth of January last, I was called to a
young married woman, in her second conhuement. The
presentation was a footling one; and previous to the
birth of the child, all circulation in the funis had ceased
for over twenty minutes, from the pressure exerted upon
it between the parts of the mother and the head of the
foetus. Upon expulsion there was com])lete asphyxia.
The face, lips, &c. were perfectly blue, and there was not
the slightest sign of animation. Without waiting to cut
or tie the funis, I immediately adopted the postural
method recommended by you, inducing artificial respira-
tion, causing that act to be performed about twenty to

142 POSTUEAL RESPIRATION IN DEOWNING

twenty-two times in the minute. In less than one
minute, the blueuess of the face and extremities had sen-
sibly diminished ; in two minutes, it had nearly gone ;
in two minutes and a half, a slight etfort at natural re-
spiration, accompanied by a sob, took place ; and in less
than three minutes and a half, respiration was fully esta-
bHshed, the child crying lustily. Only one hour elapsed
from the time I entered the house till mother and infant
(a fine, stout boy) were both comfortable and doing welL
" I conceive it to be the duty of every one who has a
case of this kind to report it to you, so that an accumu-
lation of proof of the efficacy of this beautiful life-giving
process may at once be made universally known to the
professional as well as non-professional world.

" William Cowan, ]\Lr.P. & L.G."

Case XXII.

" Hamilton, Canada, West, March 20th, 1857.
^' Sir, — On the 24th of August last, soon after read-
ing your first paper in The Lancet, I had an appalling
case of placenta prsevia. Haemorrhage continuing after
the birth of the child, extraction of the placenta neces-
sarily preceded attention to the infant, who was about
being removed as dead by the nurse, who had tied and
cut the cord. It occurred to me, fortunately, to try your
method, believing it applicable to the case of apnoea before
me; and after persevering for at least ten minutes,

AND OTHER FOEMS OF APXCEA. 143

respiration was fairly established, to the astonishment
and delight of all present, and the child is now a fine
thriving boy. Since then, in two cases of still-born
children, though not so hopeless, I have easily succeeded
in restoring animation by the same method.

" H. Cragie."

'' Be Marshall Hall."

Case I. — Of Banger from Chloroform — restored
hy Charles Hunter J Esq., of St. George's-

Life, in the following case, was preserved by Mr.
Hunter^s promptness and energy. I cannot say how
deeply I feel indebted to that gentleman for this and
many other instances of his invaluable aid in this inquiry.

"On the 28th of January, 1857, I was asked to
assist at the operation of tenotomy, in a little boy about
four years old. Chloroform was administered, and every-
thing went on well. The operation was concluded ; they
had ceased giving cliloroform, when suddenly the child
became perfectly pallid, and apparently lifeless ; res])ira-
tion had ceased. AYarm water, cold water, slapping on
the face, were had recourse to ; none of these excited
respiration in the least. Pressure on the sides of the
chest was tried, the child remaining in the supine posi-
tion. This attempt to produce artificial respiration was
no more effectual than the previous efforts to excite re-
spiration had been.

144 POSTURAL RESPIRATION IN DROWNING

" The child was now quickly placed in the p^one po-
sition, and slight pressure was made on the back ; then
rotation on to the side and a little beyond was effected.
A gasping movement of the mouth followed. The pro-
nation and semi-rotation were repeated three or four
times, when respiration was distinct; but being still
feeble, semi-rotation and pronation were continued a few
more times, with much improvement in the respiration.
The inhalation of ammonia with a httle sprinkling of
water were employed; the latter now excited inspiration.
They were repeated occasionally till the child showed that
it had regained the full power of its lungs by crying, and
it was then given into the mother's arms.

" In this case it may be remarked that the Ready
Method was not adopted at the very beginning ; it might
not have been necessary, and we should not have been
able to prove that it was. The case was, however, far
otherwise.. To the pale and apparently lifeless child
various excitants of respiration w^ere applied without
effect; also artificial respiration was employed in the
sujpine position, by the lateral compression of the thorax.
This was not attended by the slightest success, and why ?
Dr. Marshall Hall has shown that the tongue may fall
back, and that fluids may accumulate in the pharynx and
obstruct the orifice of the larynx in this position. If the
patient is to breathe again, the only remedy is to cause
the fluids to flow out, and the tongue to fall forwards ;
and this, it appears to me, can only be efi'ected by the
prone and postural method.

AXD OTHER FORMS OF APNCEA. 145

" I once saw a patient in one of the London hospitals
die under chloroform, before the operation for which it
was the preparation could be commenced. In that case,
I saw excitants of respiration employed ; I saw meclia-
nical attempts made to restore respiration in the supine
position, by lateral compression and relaxation of the
thorax. Up to this point, the case closely resembles the
preceding one. Both failed thus far. The patient, a
Vv'oman, died (the Ready Method was not tlien known).
Galvanism was applied, and there was nothing else to
try. But in the case of the little boy it was known — it
was tried — he was saved.

" I will only add this : chloroform constantly makes
patients sick during and after its administration. Tsow,
whether matters are really vomited or not, may it not be
that attempts at artificial respiration in the supine posi>
tion (in asphyxia from chloroform) have sometimes failed
because of the obstruction of the larynx and glottis by
the regurgitation of fluids from the stomach into the
pharynx? May not even the spasmodic cough which
occurs be due to irritation from the presence of these
'' foreign matters ?" Is not, therefore, the Beady Method
specially indicated in these cases ? for how can any posi-
tion but the prone remove these life-destroying liquids
and morsels ?

" I once attempted to resuscitate a still-born child.
I had a hot-bath ready, and dipped the infant in and out.
I tried other means of inducing respiration. Knowing
at that time no better way of effecting this, I applied my

H

146 POSTURAL RESPIRATION IN DROWNING

mouth to its mouthy whilst it was in the supine position.
I inflated the lungs certainly by the force I employed ; I
tried also lateral compression and relaxation of the thorax.
Every time I ceased inflating the lungs, thick grumous
fluid freely escaped from the mouth. My efforts were
useless, and I now believe I blew much fluid with air
into the lungs, existing as it did in the pharynx and
mouth.

" In cases of drowning, in still-born infants, in cases
where chloroform has caused asphyxia, fluids more or
less tenacious, according to circumstances, do, then,
obstruct the glottis ; and in such cases no attempt to
restore respiration can be effectual till the prone position
has removed the obstruction."
" Feb. 1857."

Case II — Of Banger from CJiloroform,
1)1/ JFm. Curran, Esq.

" To the Editor of The Lancet.

"Sir, — Admiring the zeal and perseverance with
which The Lancet continues to advocate that interesting
discovery of Dr. Marshall Hall, which is, I believe, from
its simplicity and readiness, likely to supersede the means
hitherto employed for the relief of apnoea, and which, in
consequence, has been so appropriately termed the
"Marshall Hall Method," I wish to communicate a
notice of the following case, in which it was practised

AND OTHER FORMS OF APXCEA. 147

with immediate benefit^ and to recommend its adoption
under similar circumstances.

'''Tiios. r , aged 54, labourer, a thin, spare man,

of weakly habit, languid circulation, and having well-
marked arcus senilis of both eyes, was brought to this
hospital on the 6th of April, having just sustained com-
pound fracture of one toe (which was soon after removed),
and such contusion and injury of the other, especially of
the large one, as to impair its vitality, and lead to the
supervention of sloughing and partial denudation of bone.

'' Gangrene destroj^ed the whole of the upper hori-
zontal half of the great toe. Mr. de Meric, therefore,
had to operate in such a way as to turn up the extremity
of the lower horizontal half towards the dorsum of the
toe to a point where some skin had been left, a portion
of the plantar aspect becoming anterior and superior, the
toe being thus newly capped after the removal of the last
phalanx. The patient was put under the influence of
chloroform in the ordniary way, and kept in a state of
unconsciousness for about, or perhaps somewhat longer
than, the usual period, without manifesting any peculiar
susceptibility, or other symptom of a suspicious nature,
until after the toes were dressed and preparation made to
remove him to bed. At this time, the breathing rather
suddenly fell, and became almost imperceptible; the
chest-play was so limited and imperfect, and the
pallor of countenance so expressive of prostration and
approaching syncope, as to require douching, sufflation,
pressure over diaphragm, and other means. These not

148 POSTURAL RESPIRATION IN DROWNING

influencing the respiration, Mr. de Meric seized him by
the body, while I held the head, and turning him alter-
nately on his side and chest, soon produced the desired
result ; the very first turn being accompanied with a puff,
which gradually became more whiffing and prolonged,
was followed by a muffled groan, and ultimately termi-
nated in deep and tranquil breathing.

" The change was so rapid and obvious as to attract
our immediate attention, and impress us with the con-
viction of its extreme value and necessity in cases of
tlireatening asphyxia from chloroform, drowning, or other
analogous cause.

" I am. Sir, very respectfully,

'' Wm. Curran.'-'

" Royal Free Hospital, May, 1857."

Note III. — Case of Danger from Chloroform.

"Chloroform was administered to a man affected
with strangulated hernia, to prepare him for the opera-
tion; asphyxia was produced; neither respiration nor
pulse was perceptible ; pronation and rotation, frictions
of the limbs upwards, the inhalation of the vapour of
ammonia — all the measures comprised in the 'Eeady
Method,^ in a word, were effectually administered ; the
patient recovered, and so recovered that the operation
was performed."

AND OTHER FOEMS OF APNCEA. 149

Note on the Fatal Case of Chloroform,
ly Janies Paget, Esq.

I do not think medical records contain anything
more admirable for prompt candour and intrinsic value
than Mr. Paget's case of a fatal result from the adminis-
tration of cliloroform. The case is as follows : — (1 have
marked in italics those words to which I would draw
particular attention.)

" The patient was a boy, nine years old, of delicate
constitution, and of nervous, timid disposition ; but with
no indication of any organic disease, except that for
which the operation was to be performed — namely, a
tumour of the scapula ; for which it was proposed to
remove the greater part of that bone.

" At half-past eight, A.ir., on February 28th, after
the patient had passed a night of sound sleep, the chlo-
roform was first administered in a room adjoining tliat in
which the operation was to be performed. He was
alarmed at the thought of being put to sleep, and of
what would then be done, and was very averse from
taking cliloroform ; but he was persuaded to inhale it ;
and, though not without resistance, yet with less than is
commonly made by patients of the same age, he was
brought under its full influence in about tliree minutes.
He sat in bed during the first few inspirations, and after
these, was recumbent. It was obseved that two or three,
deep inhalations were quickly followed by complete insen-

150 POSTURAL RESMIUTION IN DROWNING

sibility; and the next few inspirations were stertorous.
He was at once carried, in the horizontal posture, into
the room, and laid on tlie table arranged for the oper-
ation.

" Three or four minutes passed while we were ar-
ranging his position and his dress, and while I was
pointing out to those who were to assist me the proposed
plan of operation. During this time the influence of the
chloroform so far passed ofp, that he became sensible,
displaced his coverings and pillows, said something ex-
pressive of discomfort, and vomited a small quantity of
frothy fluid, (He had taken no food since the previous
night, when he had had a good supper.) A very small
(juantity more of chloroform was slowly inhaled, and he
became again nearly quiet, and was again placed on his
side. I was on the point of commencing the operation ;
but as he again, by movements, indicated some degree of
sensibility, and changed his posture, about forty drops
more of chloroform were poured on cotton wool, in-
closed in a fold of lint — an inhaler, with the chloroform
on sponge having been previously used. The lint was
lield, about half an inch from the face, by Mr. Thomas
Smith, my usual assistant in operation. The patient
inhaled lightly for a few times, then made one long
inspiration, and appeared to pass at once into deep sleep.
Except that he thus appeared to come suddenly under
the full influence of chloroform, no external change was
visible ; but a few seconds later, his pulse, wliich had
been carefully watched, and had been to this time normal.

AND OTHER FORMS OF APNCEA. 151

suddenly began to beat very quickly ; then it ceased for
two or three seconds ; then beat rapidly for several
times, with a kind of flickering movement; and then
ceased to be perceptible.

" Just before this change of the pulse was observed,
the chloroform had been withdrawn. The one deep in-
spiration was followed by a few stertorous breathings;
but after these, he breathed naturally, his complexion and
features showed no change, he seemed only calmly asleep,
and in this state he continued hreath'ing naturally ^ and
with no change in his appearance, but pidseless for at
least a minute. Then his breathing became less frequent,
and seemed as if it might soon cease ; his face grew pale,
and his lips very slightly livid.

" With the help of cold water sprinkled on his
chest and face, and cold air blo^vn on his face and throat,
he was raised from this state of defective breathing in
about two minutes, and again breathed deeply and freely,
though slowly (probably about t\Telve times in the
minute). He thus breathed ioY two or three mhiutes,
and during this time the lips, and the pale or slightly
livid parts of the face, became pink again, and though
no pulse could he felt at the wrists, the heart was heard
acting. During this time also, some wine and brandy
WTre poured into the mouth, and passed down the
cesophagus, but without any evident movements of swal-
lowing. His breathing again became gradually infrequent
and feeble. Cold air and sprinkling with water, frictions
and percussions of the chest, scarcely increased the

152 POSTL^RAL TtESPIRATION IN DROWNING

breatliing, and in less than two minutes it ceased. Arti-
ficial respiration, by the method of Dr. Marsliall Hall,
was immediately employed, and many times during the
first five minutes of its employment the artificial inspira-
tion obtained, when turning the body over to its side
was followed by a distinct, and sometimes even a full
muscular inspiration. But at the end of about five
minutes these signs of life ceased, fseces escaped, and no
more indications of life appeared, though the artificial
breathing, the friction of the limbs, and other means for
resu'=Jcitation, were continued for twenty or more minutes."

On reading this interesting case, I wrote to Mr.
Paget, and, amongst others, my letter contained the
following paragraph :

" My own idea is, that the case was not at all one
of pure a/pnoRQ, or likely to be benefited by the induc-
tion of respiration. The stertor and other defects in
])reathing were obviously the effects of narcotism of the
medulla oblongata. The absence of pulse, or suspended
circulation, the breathing continuing, establishes asphyxia
not the result of apnoea. Of these and of final sinking
the patient seems to have died, the apnoea being the
general result — the effect, not the ca^tse, of dying."

Mr. Paget^s reply corroborates my view :

" I fully agree with you as to the cause of death in
the case I have recorded. If the poor boy^s danger had
been due to asphyxia (suffocation), T feel nearly sure
that he would have been saved by your method of arti-
ficial respiration. I was struck with its e(\\}idX facility and

AST) OTHEll FORMS OF APN(EA. 155

as the remedy of ordinary asphyxia ; but I
felt, while using it, that the case was one in which it could
do no more than secure that respiration should not be
wanting if the heart should recover its power. My
beUef is, that from the time of the cessation of the pulse,
though the heart could for some minutes be heard acting,
there was no current of blood, no true circulation ; and
that the boy ceased to breathe because his blood ceased
to move."

These documents establish several new facts : first,
that the efficiency of jy^stural movements for inducing
respiration is perfect ; secondly, that, as there may be
asphj-xia the effect of apncea, so there may be apnoea the-
effect of asphyxia ; thirdly, that in the former case only,
it is to be feared, can artificial respiration be of anv
efficacy.

March 17th, 1857.

Note on Br. Snoiv's Experiments.

" To the Editor of the Lancet.

'' Ste, — Subsequent to my note on Mr. Paget's in-
teresting case, I have had my attention particularly
drawn to Dr. Snow's paper on "The Cause and Pre-
vention of Death from Chloroform.^' I especially allude
to the paper printed from the London Journal of Medicine
for April, May, and June, 1852.

"I have no hesitation in affirming that the first

154 POSTUEAL IIESPIRATION IN DROWNING

three pages of this paper are amongst the most able and
valuable in physiology, and I beg to be allowed to re-
produce them in the pages of the Lancet : —

" 'Chloroform, like other medicines which relieve or
prevent pain, is capable of causing death if its action be
carried too far. When a certain quantity of it is present
in the blood, sensibility is so far diminished that surgical
operations may be performed without pain; whilst a
certain additional quantity has the effect of diminishing
sensibility to such an extent, that the necessity for
breathing (?) is no longer felt, the i-espiratory movements
cease, and the circulation of the blood is by this means
?oon arrested. In some cases, as we shall see, sufficient
chloroform is absorbed to arrest the action of the heart
by its own influence.

(c ( ^Yhen animals, such as dogs, cats, rabbits, and
guinea-pigs, are made to respire air containing from tbree
to five per cent, of chloroform till they cease to breathe,
— a process wdiich generally occupies ten or fifteen
minutes, — the heart can be heard to beat, by means of
the stethoscope applied to the chest, for a minute or
longer after the breathing has ceased; and it often
]iappens that, about the time when the hearths action fails,
the animal makes two or three gasping inspirations,
which have the effect of restoring the contractions of the
heart, which recommence with great rapidity. If the
animal has been withdrawn from the chloroform, these
gasping insi)irations have generally the effect, when they
occur, of thoroughly re-establishing both the breathing

AXD OTHER FOIl^IS OF APXCEA. 155

and circulation ; but if it is made to breathe the chlo-
roform during these gasps, the action of the heart is
again arrested, and the natural breathing does not
return.

"'When the same kind of animals are made to
respire air charged with upwards of eight per cent, of
vapour of chloroform, death occurs with great rapidity,
and in a different manner from that just described. The
action of the heart ceases about the same moment as the
breathing. In three instances, indeed, it has ceased
before the breathing, and although gasping inspiration.s
have several times occurred after the chloroform was
withdrawn, it has rarely happened that these inspirations
have had the effect of restoring the hearf s action.

" 'I have observed the manner in which the breathing
and circulation ceased in twenty-nine instances, with tlie
stethoscope applied to the chest of the animal, when tlie
quantity of chloroform in the air they breathed was known;
but the following three experiments will sutfice to show
the different ways in which death occurs under the
influence of chloroform, according as its vapour is more
or less diluted with air. I may here remark, that the
results of the experiments mentioned in this paper can be
applied with great propriety to elucidate what occurs in
the human subject, both on account of the exact simi-
larity between the effects of chloroform on the lower
mammalia and on man, when confined within safe bounds,
and also from the close resemblance of the phenomena
caused by the less diluted vapour, to what has been
described as occurring in the accidents to patients.

156 POSTURAL EE5PirtATI0N IN" DROWNING

" ' Experiment 1. — A young but full-grown cat was
])laced in a glai>s jar, of the capacity of 1600 cubic inches^
and a fluid drachm of chloroform was introduced, by a
portion at a time, through a tube in the cover of the jar.
As twenty-five minims of chloroform produce twenty-six
cubic-inches of vapour, the atmosphere which the cat
had to breathe contained nearly four per cent, of vapour,
and the jar was moved about to ensure the uniform
mixture of the vapour with the air. In five minutes the
cat became insensible, and lay breathing naturally. In
about ten minutes more tlie breathing became very feeble,
and it ceased altogether in about another minute, or
sixteen minutes after the cat commenced to breathe the
chloroform. It was immediately taken out and laid on
;i table, and the stethoscope was applied to the chest.
The heart could be heard beating distinctly at first, but
the pulsations became slower and feebler, and in about a
juinute they could be no longer heard. Just at tliis
time, however, the cat took a gasping inspiration, and
immediately the heart was heard to beat in a most rapid
manner. The gasps were repeated, and the action of
tlie heart, became less rapid, but stronger. In a little
time both the breathing and the action of the heart be-
came natural, the cat remaining, however, insensible for
some minutes.

"'Experiment 2. — A cat, of about the same size as
the last, was put into the same jar, and the same quantity
cf chloroform was introduced. It was removed at the
and of four minutes, when it was so far insensible as to

AND OTHER FORMS OF APNCEA. 157

offer no resistance. Being laid on the table, it was made
to breathe air charged with ten per cent, of vapour of
chloroform from a bladder. Twenty-five minims of
chloroform were put into the bladder, which held 260
cubic inches, and it was filled up with the bellows. A
portion of another bladder, which was attached to the stop-
cock, was made to surround the head of the cat, and it
consequently breathed to and from the bladder. In half
a minute it was quite insensible ; in about half a minute
more, the breathing became difficult, and the sounds of
the heart less distinct. The breathing became gradually
slower, and ceased altogether between three and four
minutes after the respiration from the bladder commenced.
The sounds of the heart were rather frequent, and scarcely
audible, just before the breathing ceased, and they could
not be heard afterwards. The chest was opened tliree-
quarters of an hour after death : the lungs were of a
pale-red colour, everywhere permeated with air, and a
small quantity of fluid blood flowed from them on making
an incision ; the right cavities of the heart were quite
full of blood, and the left cavities contained a small
quantity.

" Experiment 3. — A cat was made insensible in the
same manner as the two previous ones. As it made
strong efforts to get out of the jar, and consequently
breathed more deeply, the chloroform took effect sooner ;
and it was removed and laid on tlie table, in a passive
state, at the end of two minutes and a half. The respi-
ration and sounds of the heart were quite natural. The

158 POSTURAL RESPIRATION IN DROWNING

nose of the animal was placed in the mouth of a metal
vessel, lined with bibulous paper, and used as a chloro-
form inhaler ; the inhaler contained chloroform, and was
surrounded with water of the temperature of 110° Fahr.;
the stethoscope was kept applied to the chest whilst the
chloroform was exhibited. After four or five inspirations
from the inhaler, the heart suddenly ceased to beat, the
breathing still going on ; the inhaler was removed as
soon as I was satisfied that the action of the heart had
ceased, and there were two or three rather convulsive
respirations afterwards, and then tlie breathing stopped ;
but, between one and two minutes later, there were two
or three feeble inspirations, accompanied with motion of
the nostrils, but no returning action of the heart could
be heard. The chest was opened ten minutes after
death : the lungs were quite pale throughout ; there
was a little clear serum in the pericardium ; the heart
appeared quite motionless when first observed, but, after
exposure to the air for a short time, there were some
slight contractions of a few fibres of the right ventricle;
the right auricle and ventricle were filled with blood.

" ' The air in the inhaler which this cat breathed,
probably contained between twenty and thirty per cent,
of vapour of chloroform.^

" It is obvious that death from chloroform results
from two causes, and assumes two forms : wlien the pro-
portion of chloroform in the atmosphere breathed is
hmited to from three to Jive per cent, the fatal result
Leghis with defective respiration, or ajorioea, and proceeds

AND OTHER FORMS OP APNCEA. 159

to asphyxia, and the Eeady Method is the ready remedy;
but when the proportion of chloroform amounts to uji-
ivards of eight per cent, death assumes at once the form
of asphyxia, with either simultaneous or suhseqiient apnoea,
and there is, it is to be feared, no remedy.

" This conclusion, which Dr. Snow drew from his
admirable experiments, I drew independently from an
attentive perusal of the accurate details of Mr. Paget's
interesting case."*'

In looking over Dr. Snow^s other papers, I have
been much amused, on reading a page in The Lancet of
1841-42, for October and November, pp. 133 and 212,
to see the same war waged with the Eoyal Humane
Society, in regard to the use of the icarm bath in
aspliyxia, as is being again waged in tlie present day.

Dr. Snow showed, from the experiments of Edwards,
that the warm bath must prove deleterious. Mr. WooUey
contended then, as now, and with as little reason, and
with the same discordance with physiological truth, tliat
the warm bath should be used. Unfortunately, the
remedy — the " Eeady Method " was not then discovered;
and as no method Qipromptlu producing artificial respira-
tion— the sole life-giving process — was then known,
error has continued to prevail over truth. The warm
bath is not only not remedial — it is positively destructive ;
as the merest tyro may know for himself, who will care-
fully repeat a few telling experiments.

One statement by Mr. Woolley is a little remarkable :

160 POSTURAL EESPIRATION IN DROWNING

" he had not found artificial respiration of benefit after
tlie warm bath failed to restore life " (p. 213) : neither
would he or any one else find respiration of benefit after j
not the warm bath only, but "removal, the warm bath
and galvanism/^ had been tried in vain.

The lapse of fifteen years has not detracted from the
accuracy and value of Dr. Snow's views.

We may now safely draw the following conclusions in
the present state of science :

1. The warm bath in apnoea and asphyxia is a phy-
siological and practical error.

In one case, at Boulogne, the patient having begun
to breathe, was destroyed by being put into the warm
bath.

2. In the absence of artificial respiration, the remedies
are — free exposure of the surface to the breeze, and
frictions of the limbs upwards, with pressure.

3. But the true remedy in apnoea is Respiration ; and
this is happily instantly accomplished by — the " Eeady
Method/' or, as 1 presume /must now call it — the
Marshall Hall Method.

April, 1857.

Postural Resjnration observed ly Br. Snow.

" To tlie Editor of The Medical Times and Gazette.

" Sir, — I shall be obliged if you will allow me to state
that I believe Dr. Marshall Hall's method of artificial

AND OTHER FORMS OF APNCEA. 161

restoration was quite efficient, as a method of artificial
respiration in the case of death during the inhalation of
amylene, which I related in the last number of the Me-
dical Times and Gazette. That it was not efficient in
restoring the patient is not to be wondered at, when liis
own natural respiration, continued for several minutes,
had failed to restore the action of the heart. The arti-
ficial respiration was resorted to for want of any thing
else which could afford a chance of benefit. I asked Mr.
Fergusson^s advice respecting the propriety of opening
the jugular vein, with a view to relieve the probable dis-
tension of the right cavities of the heart; but as the veins
of the neck were shrunk, and did not contain any blood,
he did not think it would be of any use to open them.
In Mr. Paget^s recent case of death during the inhala-
tion of chloroform, the patient continued to breathe after
the pulse had ceased, and the artificial respiration was
not efi'ectual in restoring him.

" When the failure of the pulse is the consequence
of the absence of breathing, as in drowning, artificial
respiration is the proper remedy ; and I believe the me-
thod of Dr. Marshall Hall to be a very efficient one. I
had, a few days ago, the opportunity of seeing its good
effects on a child born in a state of partial asphyxia.
The child presented by the shoulder, but was easily turned
by Mr. Edward Tegart, while the mother was under the
influence of chloroform. Being a large child, however,
the circulation between it and the placenta was inter-
rupted for a short time during the passage of the head.

162 POSTURAL RESPIRATION IN DROWNING

and when born, although there was a slow pulsation in
the funis, it breathed only by distant gasps ; its muscles
were completely relaxed, and it was so insensible, that
dashing cold water on it had no effect on the respiration.
The gasping was becoming less frequent, and the pulse
was failing, when Mr. Tegart and I began Dr. Hallos
method. I could hear the air entering the larynx at every
turn of the child. Its own inspirations soon became more
frequent; it became of a florid colour, in place of the
livid one it had previously presented ; its muscles began
to be tense and active, and in a very short time it was
crying vigorously.

" In any case of accident from chloroform, or any
other narcotic vapour, if the respiration were suspended
by the over-action of the medicine on the brain, and the
heart were not entirely paralysed, artificial respiration
would, I believe, restore the patient. Such is the result
of my experiments on animals ; but where the heart itself
is the organ chiefly or solely affected, artificial respiration,
although affording a chance of benefit, is likely to be of
little avail ; and these apparently are the cases of acci-
dent which have ended fatally, notwithstanding prompt
assistance.

" I am, &c.

'' John Snow, M.D."

" 18, Sackville Street, April, 1857."

AND OTHER FORMS OF APXCEA. 163

Postural Resjriration observed hy J)r. McCormac.

" Belfast, September 20, 1856.

" My dear Sir, — In my experiment as to the induc-
tion of postural respiration, I followed strictly your most
valuable suggestions. The body was that of a vigorous
man, not long dead. The right shoulder and side were
made the axis of rotation. I inclined the body forward,
in the prone position, as you direct, then raised it on the
side and beyond to an angle of about 130°. I continued
this alternating motion for some time ; but I did not
measure (I had no immediate facilities for doing so) the
amount of inspiration and expiration produced. It was
very satisfactory to me, however, to observe the gush of
air, as it entered and left the nostrils, where the transit
was more ob\aous than by the mouth.

" I had often witnessed the bubbling transit of air
thus, during the movements to which the remains of the
dead are necessarily subjected, but was far from drawing
from it the important practical inference which you have
done.

" I shall try your method of postural respiration at
the earliest opportunity, not only in the case of the
drowned, hut in other cases of asphyxiated persons — per-
sons asphyxiated from or by irrespirahle or poisonous
gases, the undue inhalation of chloroform, and by strong
drink; in all of which, your method, I conceive, is

164 POSTURAL RESPIRATION IN DROWNING

calculated, presumably, to realise the most beneficial
results.

" Permit me, my dear Sir, to subscribe myself yours
most faithfully,

"Henry McCormac."

" Dr. Marshall Hall."

Case of Narcotic Poisoning, in a child thirteen months old;
hy Charles Blades, Esq. of Tattershall.

The following case is full of the most thrilling in-
terest. Its simple details and the perseverance with
which the treatment was pursued are admirable :

" To the Editor of The Lancet,

" Permit me, through your journal, to record the
following case of narcotism, illustrating as it does Dr.
Marshall HalFs Eeady Method in cases of poisoning.

" On the 11th ultimo, at two p. m. I was called to
see a child, aged thirteen months, which had had poppy-
water given to it the previous evening. I found it in a
state of perfect unconsciousness ; there was no respira-
tion ; no pulse could be detected. I immediately adopted
the Ready Method, persevering in it for several hours !
and was well rewarded for my trouble, by first detecting,
through the fontanel, a slight motion of the brain, then

AND OTHER FORMS OF APNCEA. 165

around the umbilicus, and ultimately by the child's com-
plete recovery.

'' The successful result of this case is due to Dr. Mar-
shall Hall's plain and practical instructions in postural
respiration, published in your valuable journal.

" I am, Sir, your obedient servant,

" Charles Blades.''

" Tattershall, Feb. 1857."

" Tattershall, Feb. 28th, 1857.

" Dear Sir, — I have much pleasui'e in complying with
your request for further details of my case of poisoning.

" On making inquiries of the relatives of my little
patient, I learnt that it had been for the last few days
suffering from a cough, and that they had given it a sufii-
cient quantity of poppy- water to compose it to sleep.
It slept all night and the following morning without in-
termission, when, about twelve o'clock a. m. on attempt-
ing to give it some broth, it was seized with a fit, to
relieve which it was placed in a warm bath, but was soon
removed from thence, apparently lifeless.

'' On my arrival at the house, a little before two
o^loch p. M» I found the child lying in its grandmother's
arms, in a state of insensibility ; the eyes were closed,
the pupils contracted ; no pulse and no respiration could
be detected.

" I immediately placed it in the prone position, with
one hand under its foreliead, the other under the chest.
I commenced turning: the bodv on the side and a little

166 FOSTURAL RESPIRATIOX IN DROWNING

beyond, and tlien on the face, alternately, repeating these
measures tlnrteen or fourteen times in a minute ; at the
same time, the attendants were desired to rub the limbs
upwards simultaneously.

" I had not continued my attempts at resuscitation
more than a few minutes, when a slight motion of the
brain became perceptible, and gasping movements of the
mouth followed.

" Although no decided amendment displayed itself
for some time, yet I was fully convinced that the efficient
maintenance of the respiratory process was of the first
importance, not only to the continuance of the circula-
tion, but also as being the chief means by whicli the
.poison is eliminated. I therefore persevered in the pos-
tural movements until half-past six the same evening,
before I could pronounce my patient out of danger.

" Apologizing for not replying to your note earlier,
I remain your obedient servant,

" Charles Blades.'

" Dr. Marshall Hall."

POSTSCRIPT TO THE CASES.

§ I. — Two Cases hy Br. Lawrence, of Carmarthen.

I cannot refrain from inserting the two following
cases from the pen of Dr. Lawrence, of Carmarthen,
although they were not treated by postural respiration.
Each contains an idea of deep interest.

AND OTHER FORMS OF APNCEA. 167

The ohject of the suction in the first case was obviously
tliat of the prone position — ^^ to clear the throat /' how
far less effectual for that object I need scarcely point out.
In the supine position, part of the fluids of the throat,
though drawn out of their first position, would be apt to
flovj hacJc again when the act of suction ceased ; indeed,
the subsequent i;«spiration might draw it into the larynx.

It is singular enough that it is the very opposite to
the " mouth to mouth^^ insufflation recommended in
some cases of apnoea, as in that of the still-bom infant.

The late Mr. Eeid devised a syringe with a double
action, thinking to draw out and force in the air alter-
nately.

To be effectual, both of these objects should indeed
be combined, together with the further precaution of en-
tirely removing the danger of the fluids again falling
back, or being drawn back, into the larynx. Kow all
these objects are admirably comhined in ^rone and pos-
tural respiration alone.

The second case illustrates the subject of laryngis-
mus and. its apnoea, and shows the value of mere pressure
made on the chest, of the efficiency and safety of which,
when ' the throat is clear ^ no one can doubt ; however
otherwise full of danger.

But I proceed to give the interesting cases them-
selves :

'*■ Seventeen or eighteen years since. Dr. G. a surgeon
of Tenby, was bathing in the sea, and had a stick in his
mouth, decoying a young Newfoundland dog into the

168 POSrURAL EESPIRATION IN DROWNING

"IS

water. After being some time in the sea, he was ob-
served, by a mason on the top of a house in the town,
and by a gentleman on the Castle Hill (looking out by
St. Catherine's Eock, where there is a strong current at
the return of the sea), with the stick under his chin. It
had fallen from his mouth and kept him above water.
(A young clergyman was carried off and drowned at this
spot a few years ago.) The mason ran down, gave the
alarm, and brought him out quite lifeless. He was taken
to the Bath Eooms, and I was early in attendance. I
immediately began friction, warm applications, plenty of
fresh air by keeping all persons at a distance but my
assistants. I pressed on the chest, sides, &c. to exhaust
and inflate the lungs, and followed out a treatment tlie
same as Dr. M. Hall recommends, with two exceptions,
which I think are very important ones, and such as I
shall bear in mind at any future period : that of turning
on the face, and not using the warm bath too earlf/. I
did place my patient in a warm bath as soon as he began
to respire, in the case of Mr. G.

" I offered half a sovereign to any person who would
suck at his nose or mouth. A man came forward and did
it. Mr. G. soon afterwards drew one inspiration ; the man
of course spat out much fluid which he drew from the
lungs. The gentleman from the Castle Hill, an agent
to the late Lord Milford, seeing the eff'ect, paid the man
the half-sovereign !

" This treatment w^as suggested to me by two cases
which I read in the papers many years ago, one of which

AKD OTHER FORMS OP APX(EA. 169

I ciit out, and I enclose to you"^ ; in the other, after
failure of the medical man, a chimnev-sweeper^s boy came
forward and said " he would restore the patient." He
began the suction, and the patient recovered !"

" The second ease was one of asphyxia in a child of
my own. He was attacked with hooping-cough, the
severest case I think I ever saw, at two or three months
old. In a fit of coughing, the spasm was so severe and
of so long duration, that breathing ceased. His face
gradually became blue, his jaw and hands fell, and death
appeared to have taken place. A medical friend, who
was attending my child with me, left my house; some
little time elapsed, when I roused myself, ordered a warm
bath, and began frictions and alternate pressure on the
sides, chest, &c. &c. to inflate and exhaust the lungs;

* " Extraordinary Mode of Resuscitation." — A youth, named
Henry Rice, having fallen into the hasin, City Road, a quarter of an
hour elapsed hefore he could he got out. The hoy was conveyed to
the "Wenlock Arms, and two surgeons immediately attended, who, after
an hour's exertion, were unsuccessful in their attempts to restore the
youth to life. A drunken man in the tap-room, waking from his sleep
and learning that the medical men had failed in their attempts, stag-
gered into the room and said he would restore the boy ; and applying
his mouth to that of the youth (at the same time including the nostrils) ,
by strong suction, as if drawing the breath from the patient, actually
renovated the lad in a few minutes, to the astonishment of all present.
This was the ninth person whom this individual had restored to life
in a similar manner. This extraordinary case has excited much spe-
culation and has led to the conjecture that an instrument might be
made to answer the means adopted in these instances of resuscitation,
which would be highly beneficial in every point of view."

I

170 POSTURAL RESPIRATION IN DROWNING

and in about ten minutes the child took one inspiration,
and then gradually recovered. It was most pleasing to
see the gradual blue cloud of the face pass off, and
the natural colour return. My medical friend had ex-
pected my child was dead ; and when I requested him to
call the next day, he did not believe it was to see the
child, or that the child could be restored. He witnessed
one or two similar attacks, and my successful efforts at
recovery. I changed the air as early as possible, an
immediate improvement took place, and my child re-
covered, and is now alive."

§ II. — On obsolete Modes of Treatment.

Amongst the obsolete modes of treatment pointed out
by the Royal Humane Society, one deserves especial
notice and consideration :

" Do not roll the hody on casks"

There is in this obsolete rule an error and a truth,
equally unknown to those who first proposed it. Their
idea was that water had been imbibed into the lungs or
into the stomach, and the manoeuvre proposed was in-
tended to allow of its flowing away. This is the error.
Had the idea been fixed upon the condition of the pha-
rynx and larynx, obstructed, not with water merely, but
with mucus and fluids regurgitated from the stomach, it
would have been just and true, and the jprone position
of the patient, when placed on the cask, would have been

AND OTHER FORMS OF APNCEA. 171

the true and just means of removing those fluids, and of
" clearing the Throat I"

But the patient was " rolled'^ on the cask ; that is,
I suppose, being placed in a position perpendicular to
the axis of that vessel, he was moved so as to augment
and diminish the pressure of his body on the thorax and
abdomen, alternately. But this is precisely the effect of
' pronation and rotation !'

The only observations which this paragraph calls
forth, are— first, that the idea of getting rid of water is
founded in error ; secondly, that the result of the pos-
tural changes was not — postural Respiration. It re-
mains as a medical fallacy and curiosity — a specimen of
what passes for ' experience/

The idea of disgorging water supposed to have been
imbibed into the lungs and stomach, prevailed in the
profession. I have been shown the following paragraph by
Smollett, who, it must be borne in mind, was a physician :

" In crossing the river, my 'squire and his horse were
swept away by the stream ; and, with some difficulty, I
have been able to drag him ashore, though I am afraid
my assistance reached him too late ; for since I brought
him to land, he has given no signs of life.

" Here he was interrupted by a groan, which issued
from the chest of the 'squire, and terrified the spectators
as much as it comforted the master. After rome recol-
lection, Mr. Pillet began to undress the body, which was
laid in a blanket on the floor, and roUed from side to
side by his direction.

i2

172 POSTURAL EESPIRATION IN DBO^l^NING

" A considerable quantity of water being discharged
from the mouth of this unfortunate 'squire, he uttered a
hideous roar, and opening his eyes, stared wildly around ;
then the surgeon undertook for his recovery." ^

No one will imagine that the true effect of tliis pro-
cedure was suspected even, by its authors,

I cannot doubt that the two truths unconsciously
hidden under these propositions saved many lives. They
were, in fact, clumsy, unsuspected modes of ' clearing the
Throat,' and of ' imitating Respiration' — in a word, of
' prone and postural respiration,' whilst intending to
remove water from the bronchia and stomach, which
never existed there !

But, at least, this measure, clumsy and erroneous as
it was, was preferable to the ' warm bath' by which it
was superseded.

When recently at Eolkestane, and enquiring about the
treatment of the drowned, one boatman said his mode
was to roll the patient over and over on the ground.
Respiration would doubtless be the unlooked-for result
of such a manoeuvre.

But the real object of these proceedings was, like
that of suspending the patient by the feet, to empty the
lungs and stomach of water! Good might, in some
cases, come out of this ignorance.

In conclusion, I may observe —

1. That suctio7i would, in general, be followed by

* Smollett's Launcelot Greaves, chap. ii.

AND OTHER FORMS OF APNO^A. 173

little result, since the frothy mucus drawn into the
mouth during this operation would be probably drawn
back by the succeeding i?2spiration, the subject being in
the supine position.

2. All attempts at respiration, whether hy forcing
or by suction, would be attended, with the choking of the
air-passages by the fluids in the pharynx, the sujpiiie
position being equally observed.

More than these few observations, the subject of ob-
solete modes of treatment of the drowned scarcely deserves,
so entirely practical is the design of this little volume.

I trust I may at length add to the list, the warm
bath, the most fatal of aU, by the loss of precious time,
and of the sole real remedy, which it entails, not to repeat
the positively injurious tendency of this mistaken remedy.

I conclude that —

1. In all former postural measures— as holding the
patient up by the feet, the rolling on a cask, &c. — the
idea and the motive were to empty the lungs and the
stomach of water imbibed during the period of sub-
mersion.

I need not say that the whole proceeding was an
error,

2. That by accident resjnration might thus be pro-
duced, with its happy results.

3. That all attempts at artificial respiration in the
supine position could only be successful by a similar
happy accident — the tkroat chancing to he free.

174< POSTURAL RESPIRATION IN DROWNING, ETC

4. That mouth to mouth suction or forcing might
be successful ; but might also be ineffectual in one case,
^n^ fatal in another.

In a word, nothing is certain, nothing is safe, except
in the prone position.

The warm bath least of all.

PAET THIED.

The Begins Frofessor of Medicine y Br. Ogle^ of Trinity College^
Oxford, has issued an address to the members of Convocation, in which
he states— '■'■ The Vice-Chancellor of the University having ruled that
no one may read an address in Convocation, and my health preventing the
more obvious alternative which presents itself, I am constrained to make
known by this mode of communication the views which I entertain re-
specting the statute. Be Frofessore A^iatomice et Aldriehidno^ and which
I deem it my duty to put forth :

"I UNHESITATINGLY, CX Cathcdrd, ASSERT, THAT TO SEVER THE
STUDIES OF ANATOMY AND PHYSIOLOGY FROM THAT OF MEDICINE,
IS VIRTUALLY TO REDUCE THE LATTER SCIENCE TO A MERE EM-
PIRICISM."

§ I. — Edwards de VInfluence des Agens Phi/siques siir
la Vie.

Every one who presumes to give an opinion on the
subject of apnoea or asphyxia, must begin by a profound
study of this incomparable work ; a work to which the
discerning author devoted six years, experimenting on
every tribe of animal, at all seasons of the year.

There are three distinct chapters on apnoea. There
are the same number on the influence of temperature in
apnoea.

The general conclusions are these : —

1. The higher the temperature, within physiological
limits, the sooner the animal perishes if deprived of air.

2. The lower the temperature, also within physio-
logical limits, the longer the animal survives the priva-
tion of air.

That is the physiological limit of temperature, beyond
which, positive destructive effects are observed.

Every means, therefore, of raising the temperature
of the patient afflicted with apnoea, and not breathing, as
the continuous warm bath, and the several others recom-
mended by the Eoyal Humane Society, are deleterious.
Whilst every means of maintaining a cool temperature,
and especially the free exposure of the face, chest, and
surface generally, to the mild, cool breeze, is beneficial.

178 POSTURAL RESPIRATION IN DROWNING

These are the important conclusions to which com-
parative experiment has led the physiologist. It is
opposed to the fallacious "experience" of those, the
objects of whose observations never can be comparative,
so compHcated is the question of apnoea, and so various
the condition of the patient.

^Nothing can be more glaring than the one glaring
fallacy of substituting warmth for air, when the patient
is dying for want of air !

The truth is, the propriety of the warm bath in
apnoea is a vulgar error ; an error which physiology in
the volume of Edwards ought long ago to have corrected.

Who will pretend, after this, that medicine is not
physiological, and fail to agree with the opinion recently
expressed by Dr. Ogle, the Eegius Professor of Medicine,
of Trinity College, Oxford ?

" The Vice-Chancellor of the University having ruled
that no one may read an address in Convocation, and my
health preventing the more obvious alternative which
presents itself, I am constrained to make known by this
mode of communication the views which I entertain
respecting the statute, De Professore Anatomise et Al-
drichiano, and which I deem it my duty to put forth.
I unhesitatingly, ex cathedra, assert, that to sever the
studies of anatomy and physiology from that of medicine,
is virtually to reduce the latter science to a mere em-
piricism."

An opinion which I have long advocated. Yet little
minds still speak of " theory" as inferior to what they
term "experience,"

AND OTHER FORMS OF APNCEA. 179

Above all things, let us be frank, candid, just.

To revert to Edwards' work : warmth, previous to
the privation of air, is deleterious ; cold, beneficial. Ani-
mals die sooner of apnoea in summer than in winter.

There is still another interesting fact, which bears
upon the same subject :

Some very young animals, as the rabbit, the dog, the
cat, which are born feeble, and with the eyes closed, soon
lose their temperature, if separated from their mother and
placed singly ; others, as the guinea pig, born less help-
less, and with the eyes open, placed in similar circum-
stances, sustain their own temperature. The former
sustain comparatively a long privation of air, submerged
in water o£ the same temperature, even to half an hour ;
the latter soon perish, scarcely survi\dng the privation of
air three or four minutes.

Animals perish from apnoea the more speedily, the
greater their relation to heat, whatever that relation may
be, external or internal.

Every ray of light on this subject converges to the
same focus.

§ IL — Relation hetiveen the Dynamics and Stimuli in the

The dynamics in the animal economy are two : that
seated in the spinal system; and that seated in the
muscular system. The former is excitor ; the latter, the
excitability — the irritability of Haller.

180 POSTURAL RESPIRATION IN DROWNING

The stimuli of the animal economy are also, prin-
cipally, two : air and food.

Life consists in a series of actions and re-actions of
these several agents and re-agents; the dynamics and
the stimuli bear an inverse ratio to each other: in
the cases in which the dynamics are low in degree,
the stimuli are uniformly high ; and in the case in which
the dynamics are high, the stimuli are low. Out of the
varied condition of these, relative and absolute, the varied
forms and conditions of animated beings take their
origin.

Take an animal of high respiration, as the bird : the
stimuli, air and food, are extremely high, the dynamics
proportionately low. Choose, on the othei; hand, an
animal said to be of cold blood : its respiration and the
quantity of its food are extremly low, the dynamics high.

The dynamics in nerve and muscle, and the quan-
tities of air and food, are inversely proportionate to each
other, respectively .-

The temperature is proportionate to the stimuli, air
and food, and inversely proportionate to the dynamics.

The whole animal kingdom is subject to this law.
It is the Law of Life.

In the human subject, activity, which is a condition
of augmented stimuli, is attended by exhausted dynamics.
Repose, and especially sleep, have the contrary effect.

The embryo may be compared to the reptile in regard
to the dynamics and stimuli.

The application of these principles to the subject of

AND OTHER FORMS OF APNCEA. 181

this volume is direct : the animal bears the privation of
stimuli, air and food, in the inverse proportion to the
quantity of stimuli : the bird perishes from apncea, or
from the want of food, sooner than the animal lower in
the scale ; the infant that has breathed, sooner than the
new-born infant.

The animal reduced in temperature bears the priva-
tion of air and food better than the animal warmed by
clotliing and exercise.

In the concluding part of this volume, I propose to
return still more particularly to the interesting subject of
the Law of Life.

§ \l\.—ne Nature of Lfe.

Lfe is a slow comlustion. In all circumstances,
materials which are capable of union with oxygen, and
this gas, are brought into contact and union throughout
the duration of the vital processes. The want of food
(the fuel) and the want of oxygen (the supporter of com-
bustion) are equally the cause of the extinction of this
chemical vital process, whether it exist in the form of
flame, spark, or combustion in a still lower form.

Without fuel, or, still more to our present purpose,
without the supporter of combustion (oxygen), how can
mere external heat be efficient in producing the life-con-
stituting process ? The essential point is to bring the
combustible into due contact with the supporter of com-
bustion ; this accomplished, external temperature may ac-
celerate a process which it cannot, j!?^r se^ imitate or endure.

182 POSTURAL RESPIRATION IN DROWNING

These facts must never be overlooked by tlie physi-
cian who is called to treat a case of failing vital combus-
tion : gently to fan the smouldering embers into the real
process of combustion, which is Life, is our only hope ;
I say, " gently to fan," for too much respiration soon
may cool the doubtful embers, and extinguish life !

Who would dream of resuscitating dying embers by
warmth ? Surely either food or air is the restorative.
And let it be remembered that the two -things are not
analogical merely, but identical — for Life is a slow com-
bustion. In apnoea, therefore, in which, not fuel, but air,
is wanted, let us fan into flame the " vital spark."

It has long been a question with me, whether slow
combustion is in every case ascertained in pure oxygen
gas, and whether it is especially in the case of respira-
tion? a question to which I have already attended,
and which I propose to submit to the only true test of
comparative experiment.

The discovery that life is a true combustion has been
traced, in modern times, by Lavoisier and by Liebig. It
constitutes a great epoch in physiology.

A few days only before his most cruel death, Lavoisier
Avrote these memorable words :

'^ Ou pent done dire avec les anciens que le flambeau
de la vie s'allume au moment ou Fenfant respire pour la
premiere fois, et qu'il ne s'eteint qu^a la mort."

The spark, if not the flame of life, begins in utero,
sustained by the placental nutrition and respiration, food
and air.

AND OTHER FORMS OF APNCEA. 183

§ IV. — On the Condition of the Circulation in Apnosa,

What signs have we in cases of apnoea of a little
remaining pulsation of the heart and of circulation ? We
are, in general, too much engaged with the treatment of
the patient to observe the symptoms with accuracy. The
best plan would be to let the treatment devolve on one
person, and observation on another, when the circum-
stances permit.

1. The first object to examine is the e^e, especially
the cornea;

2. The second involves the lips and the face, the
nails and the hands ;

3. The third, the condition of the arteries and veins,
especially the pulse and the brachial veins, the carotids
and the jugulars ;

4. The fourth is the heart itself, carefully applying
the ear during a pause between the respirations ;

5. In hopeless cases, an incision may be made into
the integument, to see if blood will flow ; choosing some
part which still retains its warmth.

A¥e should watch for lividity, for flaccidity, and
endeavour to discover whether, the hand and arm being
put into hot water, a brachial vein will tumefy if under
the influence of a ligature applied round the arm.

We should watch for effects of our efforts to produce
postural respiration, especially in change of colour in the
lip and face.

]84 POSTUEAL RESPIRATION IN DROWNING, ETC,

Whatever intimation of a persistence of circulation
may be obtained from these sources, we know that, so
long as gasping or convulsive movement may continue,
we have evidence of a morbid condition or change in the
blood, in the vessels, or in the tissues of the medulla
oblongata or meduUa spinalis.

In experiments, in the midst of all these observations
the carotid may be laid bare, as was done by Legallois,
and the degrees of repletion and colour may be fuUy
observed : they present the criterion of the power of the
heart to propel blood..^

There is another source of knowledge in regard to
the persistence of the circulation, in that of the temper-
ature. But observations are wanting on this point.
The axilla and the rectum might be made the subject of
tliis inquiry.

Any indication of remaining circulation should stimu-
late us to steady perseverance in the postural respiration.
If the recorded facts of long -sustained apnoea are incre-
dible, those of the effects of perseverance hi recent efforts
to restore the patient are not less so.

I here terminate this little work. If spared, I pro-
pose to resume it hereafter. Meantime I cannot resist
the temptation of introducing a Lecture given four years
ago at the request of the authorities of the Smithsonian
Institute at Washington. The physiologist will per-
ceive its strict bearing on the vital question of Apnoea.

* " Sur le Principe de la Vie."— 1812. p. 71.

ZOONOMIA;

OR

THE LAW OF ANIMAL LIFE ;

A LECTURE,
DELIVERED AT THE SMITHSONIAN INSTITUTE, WASHINGTON, D.C. L'.
ON MARCH 8, 1853.

Gentlemen,

I congratulate myself on the opportunity afforded
me, by your kind invitation, to unfold a principle in
physiology on which I have long meditated and expe-
rimented, and which I have ventured to designate The
Law of Animal Life.

Many have been the attempts to define life. All have,
I think, proved abortive. I shall not, in my turn, ven-
ture to attempt that in which so many have failed. My
object will be rather to describe than to define.

Life, then, may be justly viewed as consisting in a
comprehensive system of action and re-action; of the
action of certain physical and chemical influences, and
the re-action of certain vital powers in organized beings.

Throughout the animal, and indeed the vegetable,
kingdoms, the primary organic agents and re-agents are
pollen and ova. Life first consists in the riciprocal action
of these upon each other. Such is the very type and
essence of life in its earliest dawn. Harvey said, Omne
vivum ab ovo. He might, with equal truth, have said,
Omne vivum a jpolline ; and, with still greater truth,
Omne vivum a polline, et ovo.

Each of them — the pollen, the ovum — was originally
a creation. Their mutual and reciprocal action is a
phenomenon which the Creator has impressed on this
portion of His works as the fiat of His will.

188 ZOONOMIA; OR, THE LAW OF ANIMAL LIFE.

That this action is perfectly reciprocal is proved by
the resemblance of the new being or offspring — be it
animal or vegetable — to botk parents. The event is at
present as inscrutable in its nature and essence, as it is
interesting to the physiologist and philosopher as a sub-
ject of observation and new inquiry.

Why t/ds seed of the Triticum Indicum, or Indian
corn, on which pollen has fallen, should, if planted
in soil, and exposed to the genial influences of heat and
moisture, become a noble and useful plant ; and why this
other, to which, from its mode of growth and treatment,
no pollen has been allowed to have access, shall, under
similar circumstances and influences, undergo decay and
decomposition, who can tell ? Why tUs egg, which has
been fertilized by pollen, should, under similar genial in-
fluences, become a bird, and eventually soar into the
regions of the atmosphere ; and why this other, unaffected
by pollen, should pass into a state of putrefaction, who
can declare ? Who will attempt to explain why those
"divinse particulse aurse,'' which exist in the form of
pollen, can alone vivify these ova ? Who can say w/mt
there is in these ova, and wkaf there is in the appropriate
pollen — for the two are equally essential — which develop
growth, and form, and life ?

Look at these ova and at these seeds. On this ovum,
and on this seed, no pollen has ever been shed. They
will, though placed in circumstances the most favourable
for development, only pass the more readily into decay.
But this other ovum, this other seed, on which pollen.

zoonomia; or, the law of animal life. 189

life-giving pollen, has shed itself, will, under similar cir-
cumstances, germinate and pass into life, the whole sub-
sequent being becoming expressly imbued with the
equally inscrutable properties of the pollen, and of the
ovum or seed.

What is the condition of this pollenized, this fructified
ovum or seed, before active life begins ? Is life in abey-
ance ? Or is it in actual existence, only in its lowest and
imperceptible form ? Have eggs and seed a temperature
of their own, above that of the medium in which they are
placed ? And what is the condition of this offset of an
animal or animalcule (as the planaria), or of this plant ?
Both will continue to live independently of the original
stem. Both may be multiplied and propagated by new
and similar offsets. Both are, as I have stated, equally
imbued with the properties of both the original pollen
and ovum. All tliis is mysterious, inscrutable in its
essence, constituting one of the arcana of organic nature,
which may long, may for ever, be hidden from us.

But the laws of life, and those of the material and
inorganic world may be detected ; and their detection
and investigation are amongst the most legitimate, inte-
resting, and important objects of philosophical inquiry.
At present, I beg only to state, that whilst pollen places
the ovum or seed under vital influences, its absence
allows them to become the prey of mere physical or
chemical agencies alone.

The further essential and distinctive characteristic of
organized beings^ that in which they differ from the

190 ZOONOMTA; OR, THE LAW OF ANIMAL LIFE.

objects of the inorganic world, is — membrane. Through
this membrane, a special function of transition takes
place, constituting endosmosis and exosmosis, or imbi-
bition and exudation.-

If this membrane be injured or broken down, the
materials of organized being are again immediately sub-
tracted from the laws of organization, and delivered over
to the ordinary principles of chemical action — decay or
eremacausis — from which that membrane had preserved
them whilst it placed them under the dominion or modi-
fication of vital influences. Examples of this fact are
afforded by bruises of animal or vegetable tissues, which,
if slight, are repaired by the vital powers ; but if severe,
lead to death or decay. How extraordinary are the
changes which almost immediately take place in bruised
flesh, or in a bruised orange or apple !

But I must hasten from these preliminary views, and
pass on to the more express subject of this lecture. All
living being, from the serpent to the eagle, possess in
common, peculiar dynamic properties ; in all, these pro-
perties respond to appropriate external and internal
stimuli. On the reciprocal play, action, and re-action,
of these forces and agents, life, with all its varied pheno-
mena, in all its varied forms, essentially depends.

These dynamics and these stimuli bear a relative
proportion to each other. This proportion is inverse;
the higher the dynamic, the lower the stimuli, and vice
versa. Such is — the Law of Animal Life,

In the animal kingdom, two forms of dynamics exist.

zoonomia; or, the law of animal life. 191

The first has its seat in the nervous system, or, more
definitely, in the spinal and ganglionic sub -systems : I
venture to designate it by the term neuro-dynamic. The
second has its seat in the muscular system ; it may be
designated myo-dynamic. The stimuli exist in greater
numbers, for they consist in physical and chemical agents
of the external world, such as air, food, water, heat, hght,
the galvanic influence, &c.

I must introduce the subject of the vital dynamics by
showing those who are not familiar with physiology an
experiment full of the deepest interest. I place before
you a frog, prepared for the purpose; and you will
observe how the most elevated principles of philosophy
may be illustrated by what you may deem the humblest
objects of creation. The physiologist knows and feels
that his science, elevated as it is, is included in the most
insignificant insect that lives — -the caterpillar or the
butterfly.

The nervous system consists in three sub-systems ;
the first is that of which the brain, or cerebrum, is the
centre, and sensation and volition the special functions.
I have removed this centre and these functions from this
frog by removing the head, and with it, the very centre
of the system, or sub -system, itself ; the creature is thus
entirely deprived of sensibihty ; the idea of suffering is
excluded. It is also deprived of voHtion ; all spontaneous
movements are impossible.

Yet there is a source and power of movement remain-
ing ; for you observe the effect of irritation of the integu-

192 zoonomia; or, the law of animal life.

meiit covering the toe or foot. This power resides in
the spinal marrow, or spinal centre, and certain nerves
proceeding to it and from it, termed therefore eisodic or
in-going, and exodic or out-going. I have designated
this power neuro- dynamic ; it was formerly termed the
vis nervosa; its English appellation would be nerve-
power.

The nerves which proceed to the centre of this spinal
system arise from the skin. I have removed the skin
from the left foot, and you will observe that the same
irritation which, applied to the right foot, induced con-
traction of the muscles, is inoperative when applied to
this denuded limb; in effect, the origin of the eisodic
nerve has been removed with the integument.

But I now irritate the spinal centre itself; you
observe the convulsions produced.

Lastly, I irritate these, the lumbar nerves ; they are
exodic, and proceed to the muscles ; again the limbs are
violently agitated by movements.

Here, then, are phenomena arising out of irritation
of the nerves, eisodic and exodic, and the centre of the
spinal system. They attest the neuro-dynamic power of
those several nervous tissues.

But there is still a third sub-system of the nervous
system ; it is termed the ganglionic, and it is connected
with all that is interior or within us. I have here placed
aside the viscera of the frog, and with them the ganglionic
sub-system belonging to them — the heart, the stomach,
the intestines, &c. If you were nearer you would see the

ZOONOMIA; or, the law of AXIMAL Lli'E. 193

heart pulsate, and the stomach and intestines move by
what is termed peristaltic action. These phenomena are
effected through the medium of the ganghonic portion of
the nervous system in which the neuro-dynamic must also
reside.

But, besides the power residing in the nervous tissues,
there is, as above stated, another dynamic. Its seat is
the muscular tissue, for which reason it may be desig-
nated the my 0 -dynamic. You observe the effect of a yerv
slight galvanic influence passed along this muscle ; the
muscle is immediately vigorously contracted. This is the
vis muscularis of physiologists, the miiscle--^Q>ys^Y,

These vital dynamics, and the physical and chemical
stimuli to which I have alluded, bear an inverse ratio to
each other. This is the case both primarily and second-
arily— the first by creation; the second, by a natural
operation and effect ; for if stimulus be diminished, the
dynamic becomes augmented ; and if the stimulus be
augmented, the dynamic becomes exhausted, and, in some
degree, proportionately reduced, as natural events, causes
and effects.

Thus the effect of hibernation, during which the
stimuli of air, food, temperature, and nutrition are re-
duced to their minimum, is to lead to augmented
dynamic and excitability, and to what may very appro-
priately be designated vernation, or the activity of spring;
whilst the effect of the augmented stimulus in the
summer months, that is, of augmented air, food, temper-
ature, and nutrition, is to exhaust or lessen the dynamic

194 zoonomia; or, the law of animal ltfe.

of nervous and muscular fibre, however they may augment
general activity and power of mass, and prepare the way
for the next winter sleep.

By creation and the operation of natural causes, then,
the inverse ratio, between dynamics and stimulus, in
animated creation, is — the Law of Life.

The attempt to invert this law in either direction, and
equalli/ in either direction, is to destroy life. Unduly to
augment the stimulus when the dynamic is high, or un-
duly to diminish the stimulus when the dynamic is low,
is equally to interrupt the vital actions.

I will again illustrate my subject by a reference to
the interesting case of hibernation : — If you take a bat
from its winter quarters, from its state of hibernation, in
which its respiration is at the minimum and its dynamic
at the maximum, and make it fly about, and so augment
the vital stimulus of respiration, it infallibly dies I If,
on the other hand, you take the same creature in its
condition of summer activity, and of high respiration and
low dynamic, and deprive it of air by immersion in water,
or in an irrespirable gas, it dies too. Invert in either
way the inverse ratio of dynamic and stimulus, and the
result is fatal.

Low dynamic req^iires high stimulus ; high dynamic,
low stimulus. The higher the d}Tiamic, the more capable
is the animal of the further abstraction of stimulus, and
vice versa. If, instead of taking a bat from its summer
activity, you take it in its state of hibernation, and now
immerse it in water for ten minutes or even longer, it is

zoonomia; oe, the law of animal life. 195

altogether uninjured. The bat, taken in its state ol
activity, and submerged in water, dies in two minutes
and a half.

Thus, the hibernating animal dies if its respiration
be augmented, whilst it can bear its suspension; the same
animal, in its state of vernation, or of activity, can bear
its respiration to be augmented, but dies speedily if it be
suspended !

I will illustrate this view by another order of facts :
The tadpole of the frog breathes in water, and feeds on
water-plants ; the same tadpole, become a frog, breathes
in atmospheric air, and feeds on insects. It has become
a higher breather — a higher feeder. In the former state,
the dynamic, in the latter the stimulus, is comparatively
greater. The tadpole would die if taken out of its ele-
ment, the water ; the young frog would drown if com-
pelled to remain in it !

These facts are the results of innumerable experiments.
I shall take occasion to revert to them hereafter.

Besides being inverse, to which there is no exception,
the ratio between dynamic and stimulus may be higher
or lower. It is in this maimer that we are enabled to
explain the modes of life. As life in general is a result
of stimulus into dynamics, we should, without a provi-
sion of this kind, see all animals equally active or inactive.
Either the reptile would not creep slowly, or the bird
tribe would not soar into the atmosphere. But we
observe, in fact, that when the stimulus is ^/i^propor-
tionately low, the animal is of low activity; and that

196 ZOONOMIA; OR, THE LAW OF ANIMAL LIFE.

when it is ^disproportionately liigli, the animal is in the
enjoyment of an intense degree of activity.

Throughout animated nature, as I have already stated,
in all the varied forms and modes of life, from the eagle
to the serpent, the dynamic and the stimuli are in an in-
verse ratio to each other. Such, as I have observed and
often repeated, is the Law of Life. In the bird tribes, the
quantity of air and food imbibed is extreme, the degree
of dynamic very low ; in the reptile tribes, the quantity
of stimulus is low, and the degree of dynamic high.

The following formulae may serve to express this
general fact :

Stimulus ... 8 ... 4 .. 2 ... 1
Dynamic ...1...2...4...8

The degree of activity, or of inactivity, in all these
cases may be supposed to remain the same; but to
explain the greater activity of the bird, and the inactivity
of the reptile, a modification of the formulae is required,
which may be thus expressed : —

Stimulus ... 1 ... 2+2 ... 4+8 ... 8+24
Dynamic ... 8 4 2 1

In this manner, whilst the inverse ratio between the
stimulus and the dynamic, generally speaking, remains,
that of the former may augment more rapidly, as we pass
into the more active forms of living beings, than that of
the latter diminishes ; and thus the bird and the insect
fly, whilst the reptile and caterpillar creep. With higher
stimulus, the animal becomes more bird-like; with lower
stimulus, it becomes more reptile.

zooxomia; or, the law of animal life. 197

"With augmented air and food, other organs, besides
those of respiration and digestion, become stimulated to
greater action. There is especially a correlation between
the rapidity of the action of the heart and of the acts of
respiration, arising in a peculiar and reciprocal manner
out of the play of stimulus and of the neuro-dynamic,
which resides in the spinal and ganglionic sub-systems
and the myo-dynamic in the muscles wliich are respectively
under their dominion, and out of the law which binds
them together, which deserves to be distinctly described.
The blood flowing through the lungs exhales carbonic
acid ; this is the internal excitor of inspiration, acting on
the fine branches of the pneumogastric nerves spread over
the lining membrane of the lungs ; the more rapid the
circulation, the greater the quantity of carbonic acid
exhaled, and consequently the more rapid the respiration.
But this respiration brings the oxygen of the atmosphere
into contact with the pneumonic blood in its turn,
through the same pulmonary membrane ; this oxygen is
absorbed by the blood, passes into the circulation, and
stimulates the heart to augmented action, and augments
the rapidity of the circulation. This last induces, in its
turn, a greater exhalation of carbonic acid in the lungs,
again augmenting respiration, &c. In proportion to the
the augmented stimulus, the dynamic is diminished.

The changes which take place in regard to the ratio
of dynamic and stimulus are of two kinds: — 1, Structural;
2, Physiological. The former, in metamorphosis, is
usually, if not always, upwards, to a state of higher

198 ZaONOMIA; OR, THE LAW OF ANIMAL LIFE.

activity, — aud to a state of higher stimulus with dimi-
nished dynamic ; the latter takes place in both directions,
being to one of higher stimulus in vernation, and to one
of higher dynamic in hibernation. Activity on the one
hand, and repose, and especially sleep, on the other,
induce similar, though less-marked, effects.

I think I have said enough to convince you, gentlemen,
that there is, in this Law of Life, a most interesting and
important fact — a vast generalization. This generaliza-
tion embraces three great objects — 1, The scale of ani-
mated being ; 2, The metamorphosis, and, perhaps, mere
development; 3, Physiological changes. I know of
no law so general, so expansive.

I may now observe that it is of deep interest to trace
the criteria of the ratio between dynamic and stimulus.

1. Galvanism is a test of neuro- and myo- dynamic,
just as nerve and muscle in the animal in which these
dynamics are high — as the frog — become galvanoscopic,
or a test of galvanism.

2. In the animal in which the stimulus is high, the
temperature and its measurer, the thermometer, become
a test of its degree, and of course of the inverse condition
of the dynamic.

3. The degree of activity, or of inactivity, denotes
the relative condition of the two elements of the Law of
Life.

4. It has already been noticed, that, in proportion to
the dynamic, and in the inverse proportion to the stimulus,
the animal possesses the power of bearing the subtraction

ZOONOMIA ; OR, THE LAW OF ANIMAL LIFE. 199

of stimulus, the privation of air and of food, and is, in
more senses than one, endowed with tenacity of life.

The length of time during which an animal can bear
the privation of air, or breathe a given Hmited quantity
of air, is proportionate to the dynamic.

5. The quantity of respiration affords a measure of
the stimulus. This is ascertained in various ways — 1,
By the structure and extent of the lungs^ ; 2, By the
number of the respirations ; 3, By the quantity of oxygen
imbibed, and of carbonic acid exhaled.

In proportion to the su)face of the luugs on which
the methaematous or blood-changing channels are spread,
in proportion therefore to the complexity of the structure
of the lungs is the quantity of respiration. The fish
has a mere gill ; the batrachiau has a vesicular lung,
with or without subdivisions or intersections, as we
observe in the triton, or in the frog or toad respectively;
the lung of the serpent, the tortoise, the tribes of the
mammalia, and of the birds, becomes more and more
complex and extended ; in the insect and in the bird,
the respiration is extended over the system, not being
limited to one organ; in the insect, indeed, each articu-
late segment is furnished with an analogue of the medulla
oblongata, as a central nervous organ of the respiration.
The dynamic exists in an inverse proportion.

6. The quantity of food assimilated or respired is a
stimulus in itself, and, in its proportion to respiration,
becomes a measure and criterion of the degree of dynamic
inversely. In speaking of the quantity of stimulus, as

200 zoonomia; or, the law of anIxMal life.

represented by the food, we must also bear in mind the
quality as well as the quantity of that food, and its
convertibility into calorifacient and nutrient principles.
Insect food is, perhaps, of all kinds of food, the most
stimulant, whilst vegetable food is the least so. It must
also be a question how much of the food is really made
available, and how much is excreted, unrespired, unas-
similated.

7. We have in the circulation a criterion of the kind
and character of life ; slow and with few methsematous
vessels in tlie animal of low stimulus and high dynamic,
it becomes quicker with more crowded vessels as the
stimulus is greater. The structure of the lung and the
degree of rapidity of the movement of the blood-globules
must be carefully noted ; as the former becomes more
complicated, and the latter augmented, the quantity of
stimulus is higher, and, I need scarcely say, the degree
of dynamic lower.

There is, indeed, no subject so replete with interest
as the circulatory apparatus — pneumonic and systemic —
in themselves, in the different orders of animated being,
and in reference to the Law of Life. The entire apparatus
consists of — 1, The minute arteries ; 2, The minute veins;
and 3, The intermediate blood channels, or, as I have
proposed to denominate them — from the important fact
that aU the changes which take place in blood take place
in them — the methsematous, or blood-changing, channels.
These vessels are specifically distinct, a distinction on
which I have insisted on anotlier occasion.

ZOONOMIA.; OR, THE LAW OP ANIMAL LIFE. 201

I must now, gentlemen, in the last place, bring before
you certain results of that Law of Life which I have
thus very inadequately sketched. In doing this, I shall
be compelled to repeat some of the preceding remarks ;
but I prefer this to the alternative of leaving my sketch
incomplete.

The first remark I have to make in regard to the
results of the Law of Life, relates to the temperature of
animals of high dynamic and of low respiration, and con-
sequently of low temperature. Such animals are said to
be of cold blood. This expression is inaccurate; no
animal is positively of cold blood. The species of lowest
temperature is still of a temperature higher than that
which would subsist absolutely without respiration, and
its blood is only low in temperature, without being as
cold as the surrounding medium.

Even amongst fishes, some are high, others low,
feeders and breathers, with a corresponding temperature.
The trout can only live at the surface of a limpid stream,
breathing highly oxygenated water, and feeding on the
insects immediately on that surface; the carp, on the
contrary, lives and breathes lowly, at the lowest parts of
stagnant pools. The trout is comparatively a fish of
higli stimulus — food and respiration — and temperature,
and uf low dynamic ; the carp of high dynamic and low
stimulus. The trout dies almost immediately, if taken
out of its crystal element ; the carp will live for days in
wet moss — that is, out of its own element, abundantly

202 ZOONOMIA ; OR, THE LAW OF ANIMAL LTFE.

supplied with moisture, or in a limited portion of water
ill supplied with mixed atmospheric air.

As we rise in the scale of animated beings, from the
fish to the reptile, from this to the mammalia, and from
these to birds, the respiration, and, with this, the tem-
perature, also rises, the dynamic proportionately falling ;
the temperature of the fish and reptile is slightly above
that of the medium in which they dwell respectively;
that of the mammalia is about 98o ; that of the bird
tribes, about 102° Fahr.

The temperature accurately coincides with the quality
and quantity of food and the quantity of respiration, and
is, in efPect, the development of an internal stimulus from
stimulant ingesta.

With temperature, there is also, probably, the evolu-
tion of the galvanic agency.

The galvanic apparatus, the thermometer, the quality
of food, the quantity of oxygen, the power to bear the
abstraction of these stimuli, or, in certain circumstances,
their addition : all these are criteria of the place a given
animal, in a given condition, ought to occupy in the zo-
ological or physiological scale.

Growth, development, metamorphosis, nutrition, in
ovo and extra ovum, are other results of the play of vital
powers, dynamic and stimulus. With each of such
changes in form, a change in kind of life, or a metabiosis,
occurs.

Of these, hints have been dispersed in the preceding

ZOONOMIA ; OR, THE LAW OF ANIMAL LIFE. 203

remarks. If T have succeeded in giving you, Gentlemen,
an adequate idea of them, and of the other topics involved
in the development of the Law of Life, I shall feel much
gratified. Pray accept my best thanks for your kind
attention throughout this imperfect lecture.

205

POSTSCEIPT.

Case of Browning, 2'^^'^^'^'^^^^^ Suhmeniony Restoration ;
ly Edward CooJc, Esc[. Guildford.

Fielder Underwood, set. 16, an intelligent lad
and a good swimmer, while in the act of winding up
one of the sluice doors of the Mill- Mead Lock, Guildford,
was suddenly immersed in the water, by the handle
slipping off. The accident occurred on the 9th of July,
at 6.15, p. M. The water was pouring with great force
through the sluice hole into the lock, and he was conse-
quently carried under the sluice door and jammed there.
A man who was standing on the opposite side of the
lock immediately ran round to his assistance, and suc-
ceeded in getting hold of the boy's hand, although he
was immersed in a depth of from four to five feet of water ;
but, although he apphed aU the strength in his power,
he could not extricate him, in consequence of the lower
extremities of the boy being drawn firmly under the sluice
door, and jammed there by the force of the current of
water in the river above.

L

206 POSTSCRIPT.

The man, finding that his efforts to release the lad
were of no avail, ran to a house two hundred yards dis-
tant for another handle (the handle having fallen into
the water with the boy). The road he had to traverse
was a difficult one ; part of the way consisted of a
narrow passage and a court-yard, he having to open a
gate to get into it ; and when he arrived at the house,
the woman who occupied it was up stairs. She imme-
diately came down and conducted the man through the
house into a back yard, where he found a handle, with
which he hastened back to the lock, and, with great pre-
sence of mind, at once determined not to wind up the
door under which the boy was pressed, lest he should
be carried by the current into the semicircular sluice
canal, but to wind up to its full height the sluice
door of the opposite side, in order to fill the lock as
speedily as possible, and take away the great pressure
of water which kept the poor boy a prisoner under
the sluice door. He therefore, instead of running
a little distance round, attempted to throw the handle
across the river to a man on the opposite side ; but in the
attempt he failed, and the handle fell into the water.
Anotlier was then sought after, by running and shout-
ing to some millers one hundred and fifty yards
distant. The handle was obtained, and the one sluice
door was wound up to its full height; and while the
lock was filling, some persons imagined that they saw
the boy's body in the agitated water which was in the
lock ; they thought that the boy had been carried through

POSTSCEIPT. 207

the sluice canal ; and hooks were immediately obtained,
but what they imagined was the boy's head turned out
to be a tuft of weed. They then directed their search in
the water above the lock, and found the body wedged
under the sluice door ; and, although the lock was filled
with water, and the pressure of water thus removed, they
found that it was necessary to apply the handle to wind
up the sluice door which was pressing upon him ; and
when that was done, they immediately lifted the body
out of the water by means of grappling hooks.

I have been particular in narrating all these minute
circumstances, in order that an idea may be formed of the
time the boy was under the water ; for he was entirely
submerged from the moment that he fell in till the mo-
ment he was taken out. Now it takes three minutes and
a half to fill the lock with water when both sluice doors
are open to their fullest extent. AYhen the accident
occurred, but a small quantity of water had ran into the
lock, and one door was wound up one third and the other
one half its height ; the latter was partially blocked up
by the boy^s body, and the former could be wound up
entirely only when the handle from the mill was ob-
tained ; therefore the time which elapsed from the period
of time that he was immersed till he was removed was
considerable, and due to the follo\\-ing circumstances :

Istly. The attempt to rescue the boy in the first
instance.

2ndly. The time lost in the efforts made to obtain
the handles, and the accidental loss of one them.

208 POSTSCRIPT.

Srdly. The endeavour to find the boy in the lock —
due to an impression that he had been carried through
the sluice canal.

The majority of those who saw the accident, and were
present during the whole period of submersion, were of
opinion that he was in the water more than ten minutes.
From the time it occupies to fill the lock, combined with
other circumstances, / infer that he must have been sub-
merged from seven to eight minutes, and certainly not
less than seven.

I arrived on the spot immediately after he was taken
out of the water. The surface of the body was cold, the
lips and cheeks blanched ; there were no signs of respira-
tion ; the heart was still ; the body was to all appearance
inanimate — lifeless. The muscles were very relaxed. I
immediately obtained the assistance of several of the by-
standers, and first stripped the body of its clothing. I
placed one man at each leg, one at the back, and one at
the head to guide it right in the rolling, and another to
administer a solution of heartshorn occasionally to the
nostrils. I drew the tongue well forward, and saw that
the throat was unobstructed. I then proceeded to act
according to the rules of the Marshall Hall Method — my
kind assistants rubbing the surface of the extremities
back, &c. while I rolled the body from fifteen to eighteen
times per minute. This was done on the grass, within
fifteen yards of the spot where he was taken out. After
from five to seven yninutes, the first gasp or inspiration
was noticed ; the next, in about half a minute ; and then

POSTSCRIPT. 209

occurred about once in twenty seconds, more or less,
and with some irregularity for from fifteen to twenty
minutes; and after that time, the respirations became
more frequent. At the end of thirty -five minutes or so,
he breathed without my assistance, and the pulse could
be felt at the wrist ; but pulsation was felt in the femoral
artery in Scarpa's triangle some minutes before it was
felt at the wrist. After having thoroughly ascertained
that he could breathe, I had him wrapped up in a blanket
and conveyed home, where he was put to bed. The
surface of the body was still cold ; he was unconscious,
and could not be roused by loud talking, &c. The pupils
were much dilated. Respirations, 25, short and op-
pressed. Pulse weak, 50. Hot- water bottles were
applied to his legs and feet, and a free current of air
admitted through the room. At half-past seven p. m.
Mr. Sells saw him, and recommended the application of
a mustard cataplasm to the chest and abdomen. The pulse
had risen in volume and frequency, being 64, and the
respirations from 30 to 82, still very much oppressed ;
and on oscultating the chest, rough mucous crepitation
and bronchial wheezing could be heard. The mustard
plaster appeared to give him great pain ; it remained on
ten minutes, and made the skin red.

Mr. Sells again saw him with me at half-past nine
p. M. The pulse had increased to 104, and the res-
pirations to 52 ; excessive reaction had taken place, the
surface of the body was very hot and dry, he was still
unconscious, the dyspnoea very great. We made an

210 POSTSCRIPT.

attempt to give him a little water out of a teaspoon, but
he made no effort to swallow.

At midnight he swallowed a teaspoonful of warm tea,
and said that it was " too sweet ;" these being the first
words he uttered after the occurrence of the accident ;
he slept till five a. m.

10th. At half-past six a. m. the skin was hot and
dry, pulse 88, weak ; respirations, 32 ; much oppressed,
has not answered to any questions put to him. At half-
past seven a. m. bowels relieved, and a large quantity of
urine passed. Half-past nine, a. m. ; is perfectly con-
scions, and cheerful ; has no knowledge of the accident,
and disbelieves its occurrence ; he does not even recollect
going to the lock. Complains of soreness and stiffness
of the limbs. The surface of the extremities is still cold,
but the surface of the other parts of the body is hot and
dry. Hot flannels appHed to the legs and feet ; pulse
90, weak; tongue, white; six grains of calomel to
be taken directly. At noon, vomited a small quantity
of what appeared to be pure bile, persjnres freeli/ , pulse
90, stronger; eat a small quantity of hght pudding;
breathing much easier.

11th. Was purged freely several times by the calo-
mel; enjoyed a good night's rest; pulse 80, soft and
rather weak; respirations 25, deeper, and more natural;
the temperature of the lower extremities was lower than
of other parts of the body, and warmth was still applied ;
has no headache ; complains of feeling stiffness in the
limbs.

POSTSCRIPT. 211

A grain of calomel was given at niglit, and a senna
draught the following morning.

12th. Stomach irritable ; vomited after taking the
pill and draught ; tongue less wliite ; pulse 84, stronger.
To have light diet.

July 13th. Health improved in all respects, and
considers that he is *' himself again."

Edwaed Cook,

Assistant to Messrs. Stedman, Sells, and Stedman,
Surgeons, Guildford.

1 trust that this important case, with its details, will
lead to a renewed and more careful observation of the
length of time during which the human subject may be
deprived of respiration, without extinguishing all hope of
restoration.

INDEX.

PART FIRST.

SECTION PAGE

I. — Introduction 1

II. — The Distinction between Respiration and the Respi-
ratory Movements in Apnoea 3

III. — Relation of Respiration to the Circulation 6

IV. — The Rationale of the Effects of Suspended Respiration 9
V. — The Effects of Apnoea chiefly the result of the Reten-
tion of Carbonic Acid 14.

VI. — On the Influence of Temperature, and on the Warm-
Bath 17

VII. — The former Modes of Treatment of Asphyxia 20

Reflections, 22

VIII . — New Modes of Treatment of Apnoea, 25

IX. — New Rules for the Treatment of Asphyxia 80

X. — On the Apnoea of Still-born Infants 34

XL — On Secondary Apnoea 37

XII. — Recapitulation 38

XIII.— The Royal Humane Society 40

214 INDEX.

PART SECOND.

SECTION PAGE

I. — The Royal Humane Society 45

II. — More detailed Rationale of Apnoea 50

III.— The Apnoea of Still-born Infants 56

lY. — On Prone and Postural Respiration 60

V. — On the Inhalation of dilute pure Ammonia in Apnoea 72

VI. — Of the Inhalation of Oxygen 74

VII. — The Rationale of the fatal tendency of the Warm

Bath in Apnoea 74

VIII.— The Danger of all Attempts at Artificial Respiration,

except in the Prone Position 79

IX. — On the Prognosis in Apnoea 84

X. — On Narcotic Poisoning 89

XI. — The Laryngismus of Chronic Laryngitis...-. 91

XII. — The Laryngismus of Convulsion and of Epilepsy .... 91

XIII. — The Laryngismus of Strychnine 93

XIV. — The Laryngismus of Choking 94

XV. — On the Time the Patient may be submerged 96

XVI. — Formulae for Prone and Postural Respiration 98

CASES.

I. CASES OF DROWNING,

CASE

I — By Dr. Alexander, of Dundonald, Kilmarnock 105

II.— By Dr. Hadden, of Skibbereen 106

III.— By Dr. A. Legat, of South Shields 112

IV. — Improperly treated — fatal. ByDr. A. Legat 115

v.— By Ernest P. Wilkins, Esq. of Newport 117

VI.— By Mr. Richard Ellis, of Bishops-Auckland,

Durham 118

VII. — Onboard the Dreadnought, by F. M. Corner, Esq... 120

INDEX. 215

II. CASE OF SUFFOCATION.

PAGE

Case of a Man overwhelmed by the fall of Earth ; com-
municated by James F. West, Esq 121

III. cases of the STILL-BORN.

I. — By Marshall Hall Higginbottom, Esq. of Notting-
ham 125

II.— By Charles Yaudin, Esq. of St. Heliefs, Jersey..,. 128

III — By Dr. NichoUs, of Wiveliscombe, Somerset 131

IV.— By J. T. Savory, Esq. of Wendover 132

V. — By J. C. Chappell, Esq. George Street, Hanover

Square, 134

additional cases.

YI to XIY 135 to 142

IV. cases of danger from chloroform.
I. — Case of Danger from Chloroform— restored by

Charles Hunter, Esq. of St. George's 143

II. — Of Danger from Chloroform, by Wm. Curran,

Esq 146

Note. — Case of Danger from Chloroform 148

Note on the Fatal Case of Chloroform, by James Paget,

Esq 149

Note on Dr. Snow's Experiments 153

Postural Respiration observed by Dr. Snow 160

Postural Respiration observed by Dr. McCormac 1 63

V. case of narcotic POISONING.

Case of Narcotic Poisoning in a Child thirteen months old ;

by Charles Blades, Esq. of Tattershall 164

postscript to the cases.

I. — Two Cases by Dr. Lawrence, of Carmarthen 166

II. — On obsolete Modes of Treatment 170

216 INDEX.

PAET THIRD.

SECTION

I.— Edwards de I'lnfluence des Agens Physiques sur

la Vie 177

II. — Relation between the Dynamics and Stimuli in the

Animal (Economy 179

III.— The Nature of Life 181

IV. — On the Condition of the Circulation in Apnoea 183

ZOONOMIA ; OR THE LAW OF ANIMAL LIFE;

A Lecture, delivered at the Smithsonian Institute, Wash-
ington, D. C. U. S. on March 8, 1853 184

POSTSCRIPT.

CASE OF DROWNING.

Case of Drowning, Protacted Submersion, Restoration ; by

Edward Cook, Esq. Guildford 205

RECENTLY PUBLISHED BY THE AUTHOR, IN PARIS,

COUP D'CEIL DU SYSTEME SPINAL.
FINIS.

PRINTED BY J, MALLETT, WARDOUR STREET, LONDON.

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